(Acknowledgment by Individuals - Multi-Party Instrument) (Jurat for an Individual Affiant) REPUBLIC OF THE PHILIPPINES) CITY/MUNICIPALITY OF ______) SS.

x-----------------------------------------x ACKNOWLEDGMENT BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _____________, personally appeared the following persons, with their respective Community Tax Certificates as follows: Name C.T.C. No. Date / Place Issued _____________ _____________ _____________ NOTARY PUBLIC Doc. No. ______; Page No. ______; Book No.______; Series of 20____. SUBSCRIBED AND SWORN to before me, this _____________, by the Affiant who is personally known to me (or whom I have identified through competent evidence of identity) and who exhibited his/her Community Tax Certificate No. _____________ issued at _____________ on _____________.

1. _____________ _____________ 2. _____________ _____________ 3. _____________ _____________

all personally known to me (or whom I have identified through competent evidence of identity) and who represented to me that their respective signatures on the foregoing instrument were voluntarily affixed by them for the purposes stated in the instrument and who declared that they have executed the foregoing instrument as their free and voluntary act and deed. This Instrument consists of only ______ (____) page/s, including this page in which this acknowledgment is written, duly signed by the parties and his 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 20____.