B26-Form2SS-PSRA Initiative Signature Collection Sheet

IMPORTANT: If COMELEC has prescribed a form, use the COMELEC form instead of this form.

PSRA INITIATIVE

This form must be reprinted in as many quantities or copies as are required to accommodate all needed signers to the petition in this City.
Be sure to gather signatures of no less than 10% of all registered voters in the entire City in the last election and in which at least 3% of each
legislative district is represented as required in RA 6735, the Initiative and Referendum Law. It can contain only 30 lines for signing.
Notice to Signature Solicitor: Fill in first the following blanks before starting to solicit signatures of registered voters.
Signature Sheet for the Registered Voters in the City and/or Province of ____________ - Legislative District No. _____________
(The blanks below to be filled in by registered voters ONLY FOR THIS DISTRICT. Make separate sheets for another District)
Petition to the Commission on Elections: The Filipino People propose to legislate Public Service Reformation Act to implement Article
2, Section 26, of the Constitution: 1. To stop political dynasties in public service; 2. To require all political parties to hold a summit political
pre-election convention to consolidate themselves into two major popular parties to nominate their respective candidates for election to a
public office on election day; 3. To adopt the block voting system; 4. To prevent election, appointment, or promotion of any person who is
in conflict of interest. 5. To ensure winning candidates are elected by majority of voters.
Signing Instructions: Print Name, Barrio, Congressional District, and Signature of Voter in that Sequence.

(Important: Sign in for sim ilar Congressional District residents only. Do not mix different districts in the same sheet)
Print Voters Name (Good hand
Printer may help but must not sign)

Type of Voters
Identification Certificate

Name of Barangay
Where the Voter Resides

Registered
Voters Signature

WITNESS CERTIFICATE : We certify under penalty of perjury that each signature on this sheet is an authentic signature, written or affixed
by each person it purports to be. We understand, speak, read and write the local dialect of said person. Before signing, We interpreted
its contents to him or her in his or her local dialect and has voluntarily signed it in our presence and view on (Date) :________________
Signature
Printed Name
Title

Witness and Solicitors Representative

Signature Collection Supervisor

PAGE NUMBER (Please leave blank. To be filled in only by the Petition Preparer before the COMELEC): _________________