REPUBLIC OF THE PHILIPPINES)
PROVINCE OF _______________ ) SS
MUNICIPALITY OF ___________)
BEFORE ME, this ________day of ___________, 20___ in the Municipality of _____________, Province of ____________, Philippines, personally appeared _____________________, with Residence Certificates A No. ___________ and B No. ____________ issued at ______________, on _________________, 20_____, respectively, and BIR Tax Identification No. __________________, known to me to be the same person who executed the foregoing instrument, and he acknowledged to me that the same is his free act and deed.
This instrument, consisting of ________ pages, including the page on which this acknowledgment is written, has been signed on the left margin of each and every page thereof by ____________________ and his witnesses, and sealed with my notarial seal.
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 Dec. 31, 20__
Not. Reg. No.____________________;
Page No.________________________ ;
Book ___________________________;
Series of 20___________