REPUBLICOFTHEPHILIPPINES

REGIONALTRIALCOURT
7THJUDICIALREGION
Branch____
___________City

PETITION FOR APPOINTMENT AS NOTARY

INRE: PUBLIC FOR THE CITY OF _____________ CASE NO:________
AND THEMUNICIPALITIES UNDER THE
JURISDICTION OF THIS HONORABLE
COURT

________________________________
(NameofApplicant)
Petitioner
x/

PETITION

PETITIONER, _________________, unto this Honorable Court, most

respectfullyalleges:

1. Petitionerisof___yearsold,forhavingbeenbornon____________.
He/She is a Filipino Citizen, married, has been a resident of
_______________,Philippinessincehis/herbirth.She/Heiswiththe
office address and regular place of business at
_________________Philippines with telephone numbers: (032)
_________________ and 09_________________ ; and in which
jurisdictionhe/shenowappliestobegivenaNotarialCommission.In
theevent,however,thatthePetitionerceasestomaintaintheaforesaid
place of business, he/she hereby undertakes to notify this Honorable
Courtwithinten(10)daysfromsuchchangeofbusinessaddress;

2. He/She has never beencharged or convicted of any crime involving

moralturpitude,andherewithattachedisaclearancefromtheRegional
Trial Court __________ City, as ANNEX A of this Petition; and
ClearanceissuedbytheNationalBureauofInvestigation(NBI)dated
__________hereinattachedasANNEXA1

3. He/SheisamemberofthePhilippineBarwithRollNumber________,
asevidencedbyCertificateofMembershipinthePhilippineBardated

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 __________,acopyofwhichisheretoattachedas ANNEXB and
madeandintegralpartofhereof;

4. He/Shehaspaidhis/herprivilegetaxesfortheyear2016asevidenced
byProfessionalTaxReceiptNo._____,dated__________,acopyof
whichisattachedheretoandmadeanintegralparthereofas ANNEX
C;

5. He/She is a member of good standing of the Integrated Bar of the

Philippines,beingamemberthereof,asevidencedbyaClearancefrom
theIntegratedBarofthePhilippinesCebuChapterandforwhomtwo
(2) executive officers of the Integrated Bar of the Philippines Cebu
ChapterissuedaJointCertificationofhis/herbeingamemberofgood
standingandofhis/hergoodmoralcharacter,whichJointCertification
isattachedas ANNEXD herewith;likewise,aClearancefromthe
OfficeoftheBarConfidant,dated___________isattachedherewithas
ANNEXE;

6. He/ShehaspaidtherequiredIBPMembershipDuesforCY2016,and
BuildingFundcontributiontotheIntegratedBarofthePhilippinesas
evidencedbyOfficialReceiptNo.___________,dated_____________,
acopyofwhichisattachedheretoandmadeanintegralparthereofas
ANNEXF;

7. Three(3)unretouchedpassportsizecoloredphotographsofPetitioner,
taken within thirty (30) days before the filing of this Petition, with
his/hersignatureatthebottomthereonisattachedherewithasANNEX
G;

8. Facsimilesofpetitionerssignatureappearonthesheetofpaperattached
heretoandmadeanintegralparthereofasANNEXH;

9. Thatproperandadequatepaymentismadeforthefilingofthispetition
asrequiredbytherules.OfficialReceiptasproofofpaymentisincluded
inthispetitionas:

RTCO.R.No.__________,dated___________,=P=________;

RTCO.R.No.__________,dated___________,=P=________;

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 RTCO.R.No.__________,dated___________,=P=________;

10. Petitioner has not applied for commission in any other court of the
Philippines.

PRAYER

WHEREFORE,itisherebyrespectfullyprayedthatPetitionerbegrantedan
appointment as Notary Public for and in the City of _____________ and in the
Municipalitiesof_____________PhilippineswithinthejurisdictionofthisHonorable
Court,foryear2016untilDecember31,2017.

Also Petitioner prays that he/she be issued a certificate of authorization to

purchaseaNotarialSeal.

Respectfullysubmitted.

Donethis_____________in_____________Cebu,Philippines.

Atty._________________
Address
RollNo._______
PTRNo.___________________
IBPNo.___________________
ExemptPursuanttoMCLEGoverningBoardNo.1
Seriesof2008
AdmittedJune________2016
Contact#________________/Email______________

3
RepublicofthePhilippines)
Cityof________________)S.s

VERIFICATIONANDCERTIFICATIONOFNONFORUMSHOPPING

I,___________________,legalage,Filipino,single/married,andaresidentof
______________afterhavingbeensworntoanoathinaccordancewiththelaw,depose
andsay;

ThatIamthePetitionerintheaboveentitledproceedingsthatpreparedtheforegoing
petition;

ThatIhavereviewedthePetitionandtheallegationsthereinaretrueandcorrectbased
onmypersonalknowledgeorbasedonauthenticrecords.

Further, I certify that I have not filed any other petition for issuance of notarial
commissioninanyothercourtortribunalinthePhilippines.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

________________in______________,Philippines.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this ______________ in the City of

____________,Philippines,affiantexhibitedtomehis/hercompetentproofofidentity
indicatedas:_____________________.

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Doc.___
Page___
Book___
Seriesof2016.