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Republic of the Philippines REGIONAL TRIAL COURT __Judicial Region Branch ___ _____City

IN THE PETITION FOR COMMISION AS NOTARY PUBLIC IN AND FOR THE PROVINCE OF _____________

___________________________, Petitioner. x------------------------------------------------------------x

PETITION
Petitioner, to this onorable Court, respectfully states that! 1. "he is of legal age, ha#ing been born on _______, single, $ilipino citi%en and presently residing at _____________________&

'. "he has been admitted to the practice of la( in the Philippines as sho(n by the Certificate of )dmission to the Philippine Bar, (hich contains the Petitioner*s Roll of )ttorney No. +',,'. ) copy of the Certificate of )dmission to the Philippine Bar is attached and mar-ed as Annex A hereof&

3. "he is a member of good standing of the Philippine Bar as sho(n by the clearance issued by the .ffice of the Bar Confidant of the "upreme Court a copy of (hich is attached as Annex B hereof&

/. "he is li-e(ise a bona fide member of the 0ntegrated Bar of the Philippines. ) photocopy of her 0BP Receipt sho(ing her 0BP No.13/132 is attached and mar-ed as Annex C hereof. )lso attached and mar- here(ith as Annex D is the Certificate of petitioner*s good moral character issued by )tty.____________________ and )tty. ____________________, President and "ecretary, respecti#ely, of 0BP ___________ Chapter&

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2. "he has also paid the Professional 3a4 Receipt due her as e#idenced by P3R No. ________, dated __________, a photocopy of (hich is also attached here(ith as Annex E&

+. "he has all the 5ualifications and none of the dis5ualifications for the .ffice of the Notary Public&

6.

"he has ne#er been charged nor con#icted of any crime in#ol#ing moral turpitude&

7. "he has no commission as notary public in any other 8urisdiction&

1. "he has attached hereto in a separate sheet of paper specimen of her official signatures and mar-ed as Annex F and made an integral part hereof& 1,. "he has li-e(ise attached thereto his three 93: passport si%e photographs each bearing her signature on the bottom part thereof as Annex G hereof&

11. "he has been issued an )ppointment as Notary Public by this onorable Court on _________ (hich appointment ends on __________, attached here(ith is the said )ppointment as Annex H , and a true impression of her notarial dry seal made pursuant to la( as Annex I , respecti#ely& and

WHEREFORE, Petitioner respectfully prays that she be commissioned as Notary Public for and in the Pro#ince of _______.

Respectfully submitted.

____________________, Philippines.

Petitioner

Roll No& Page No& Boo- No. 0 0BP No. 13/132 Chapter P3R No.

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Republic of the Philippines Pro#ince of ____ City of _____

: : "." :

4;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;4

VERIFICATION
0, ______, $ilipino, of legal age, single and a resident of ______ City, after ha#ing duly s(orn to in accordance (ith la(, do hereby depose and say that! 1. 0 am the petitioner in the abo#e;entitled Petition& '. 0 ha#e caused the preparation of the foregoing Petition& and 3. 0 certify that 0 ha#e read and understood the contents thereof and #erify that the facts stated therein are true and correct based on my personal -no(ledge and authentic records.

IN WITNSESS WHEREOF, 0 ha#e hereunto affi4ed my signature this ______ day of ______, ',13, at ______________.

Petitioner;)ffiant

SUBSCRIBED AND SWORN TO BEFORE ME in the City of ______________ this______ day of______, ',13 by ______________, a person -no(n to me and to me -no(n to be the same person (ho personally signed before me the foregoing Petition and ac-no(ledged that she e4ecuted the same, and e4hibiting to me her _______ as competent proof of her identity.

_____________________ )dministering .fficer

<oc. No. ______& Page No. ______& Boo- No. ______& "eries of ',13.

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ANNEX A C=R30$0C)3= .$ >=>B=R" 0P 0N 3 = P 0?0PP0N= B)R 9P .3.C.P@:

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ANNEX B C=R30$0C)3= .$ A..< "3)N<0NA $R.> .BC

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ANNEX C P .3.C.P@ .$ 0BP R=C=0P3

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ANNEX D C=R30$0C)3= .$ A..< >.R)? C )R)C3=R $R.> 0BP B_________ C )P3=R

INTEGRATED BAR OF THE PHILIPPINES ______Chapter ________ City

CERTIFICATION
3 0" 0" 3. C=R30$@ that ATTY _______ of _________ is a >ember of the 0ntegrated Bar of the Philippines per her 0BP No. ______ and is a bona fide member of the 0ntegrated Bar of the Philippines, ______Chapter, Philippines. 3his certification is issued upon the re5uest of ___________ for all legal intents and purposes. ___________, Philippines, ___________.

)33@._______________________ Chapter "ecretary

)33@._______________________ Chapter President

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ANNEX E P .3.C.P@ .$ P3R R=C=0P3

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ANNEX F

"P=C0>=N "0AN)3CR=" .$ )33@.

1. __________________________________

'. __________________________________

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ANNEX G P .3.AR)P D03 "0AN)3CR=

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ANNEX H

Republic of the Philippines REGIONAL TRIAL COURT _______ Judicial Region OFFICE OF THE EXECUTIVE !UDGE ______ City

APPOINTMENT

B= 03 EN.DN 3 )3! ATTY ________ is a resident of ________ss City, Philippines, is appointed by me as N.3)R@ PCB?0C for and (ithin the Pro#ince of ________, Philippines, for a term starting from the ____________________ day of __________ to _____________of ____________ )nno <omini, 3(o 3housand 3hirteen 9',13:.

A0F=N CN<=R >@

)N< and caused the "eal of this Court to be affi4ed

thereon, this____ day of ___, )nno <omini, 3(o 3housand 3hirteen 9',13: at the City of _______, Philippines.

=4ecuti#e Judge

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ANNEX I
3RC= 0>PR=""0.N .$ 3 = N.3)R0)? <R@ "=)? .$ )33@.