Form 1 - Initiative Signature Collection Sheet CONSTITUTIONAL AMENDMENT ONE INITIATIVEIf COMELEC has prescribed a form, use the COMELEC form instead of this form.

This form must be reprinted in as many quantities as are required to accommodate all needed signers to support the petition. Be sure togather signatures of no less than 12% of all registered voters in the entire country in the last election and in which at least 3% of eachlegislative district is represented as required in RA 6735, the Initiative and Referendum Law. This page contains 30 rows 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 Sovereign People of the Philippines propose to amend their Constitution to be knownas AMENDMENT ONE. Its purpose is to basically change the election of Senators by Districts instead of by election at large inorder to speed up economic growth all around the Philippines. The Country shall be apportioned into 17 Senatorial Districts and eachdistrict shall be represented by two native born residents in their district, and are registered voters elected for a six-year term and

may be re-elected for a second last term. It shall further establish Federal Regions.

Signing Instructions: Print Name, Voters ID, Congressional District, and Signature of Voter in that Sequence.(Important: Sign in for similar Congressional District residents only. Do not mix different districts in the same sheet)

Printed Name of RegisteredVoter/Petitioner

Signature of RegisteredVoter/Petitioner

A d d r e s s Date

of BirthBarangay Municipality or City

WITNESS CERTIFICATE : We certify under penalty of perjury that each signature on this sheet is an authentic signature, written or affixedby each person it purports to be. We understand, speak, read and write the local dialect of said person. Before signing, We interpretedits 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 Signature Gathering Deputy Witness for the COMELEC Deputy or Representative

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