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ANNEX B

C.E. Form No. 35

Republic of the Philippines


COMMISSION ON ELECTIONS
_______________________________________
(City/Municipality, District, Province)

______________________________
(Region)

SYNCHRONIZED BARANGAY AND SANGGUNIANG KABATAAN ELECTIONS


OCTOBER 28, 2013

CERTIFICATE OF CHALLENGE/PROTEST AND


DECISION OF THE BOARD OF ELECTIONS TELLERS/ SPECIAL BOARD OF ELECTIONS TELLERS

INSTRUCTIONS:
PREPARE IN FOUR (4) COPIES. Deliver one copy to the member of the Board; voter or watcher making
challenge or protest; one copy to the individual against whom the challenge or protest is made; and one
copy to the watcher who will be requesting for a copy hereof. The Board shall retain the third copy.

Precinct No. __________________________ District: ________________________


Barangay: ___________________________ Province: _____________________
City/Municipality: _____________________ Region : _____________________

We hereby certify that on _________________________________________________, 2013,


_________________________________________________________________________________ of
(Name of Challenge/Protestant)
____________________________________________________________________________________
(Address)
MADE THE FOLLOWING CHALLENGE/PROTEST:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________________________
(State nature or ground for challenge/protest and name of individual against whom the
challenge/protest is made)

The Board, after considering the evidence presented to it, DECIDED as follows:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________________________
_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________

IN WITNESS WHEREOF, we hereby sign the Certificate this _____day of ______________, 2013.

_________________________________
Chairman
(Signature over Printed Name)

__________________________________ _________________________
Poll Clerk Third Member
(Signature over Printed Name) (Signature over Printed Name)

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