REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF _______) SS.
ACKNOWLEDGEMENT
BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of
________________________, personally appeared __________________________ with
Community Tax Certificate No. _________ issued on _____________ at ______________, and
Tax Identification Number (TIN No.) ______________ known to me and to me known to be the
same person who executed the foregoing instrument which (he/she) acknowledged to me as
(his/her) free and voluntary act and deed, consisting of only ______ (__) pages including this
page in which this Acknowledgement is written, duly signed by (him/her) instrumental witnesses
on each and every page hereof.
WITNESS MY HAND AND SEAL this ___________ at ___________, Philippines
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. ____ ;
Series of _____.
JURAT
SUBSCRIBED AND SWORN to before me this ____ day of __________, 20__, in the
City of _________, by ____________________ with Passport ID Number _________________
issued on ________________ at __________________.