REPUBLIC OF THE PHILIPPINES )

PROVINCE OF _______________ ) SS
MUNICIPALITY OF ___________ )
BEFORE ME, this ________ day of _________, 20___ in the Municipality of
_______________, Province of ___________________, Philippines, personally appeared
_________________________, representing to be the President (or Manager) of
____________________, known to me to be the same person who executed the
foregoing instrument, and he acknowledged to me that the same is the corporate act and
deed of _________________, and that he is duly authorized to sign the same. The said
_______________________ exhibited to me his Community Tax Certificates No. issued
at ________________, on ____________, _______________ 20__.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial
seal, the day, year and place above written.

NOTARY PUBLIC
My commission expires on Dec. 31, 200_
IBP No. ____________/ 01 Jan. 2010
PTR No. ____________/ 01 Jan. 2010
Roll No. 123456
MCLE No. III-123456
Doc No. ______;
Page No. ______;
Book No. ______;
Series of 200__.