Republic of the Philippines

Regional Trial Court

OFFICE OF THE EXECUTIVE JUDGE
IN RE: PETITION FOR NOTARIAL COMMISSION
FOR DUMAGUETE CITY AND THE
MUNICIPALITY OF BACONG, DAUIN, ZAMBOANGUITA, SIATION, SIBULAN and
VALENCIA, and all of the Provinces of Negros Oriental
(NAME)
Petitioner,
X------------------------------------------------------------------------------------------------------------------/
PETITION
Petitioner, respectfully alleged that:
1. She is of legal age, Filipino citizen, born on June 20, 1991, single, a resident of
Dumaguete, Negros Oriental.
2. She is a member of good standing of the Integrated bar of the Philippines (IBP), Negros
Oriental Chapter, having been admitted to the Bar in 2014 with Roll of Attorney Number
38822.
3. She has never been charged or convicted of any criminal or administrative offense, and
that he is possessed of all the qualifications and none of the disqualifications for a Notary
Public;
4. She has paid the filing fees for this Petition;
5. In support of this Petition, she is submitting the following documents with their
respective purpose;
a)

Certifications from the Office of the Bar Confidant and the IBP-Negros
Oriental Chapter, hereto attached as ANNEXES A & B, respectively as
proof of her good moral character.

b) She has paid her annual Integrated Bar of the Philippines dues and her
professional tax for the year 2013. Photocopies of the receipts for the said
payments are hereto attached as ANNEX C and D, respectively.

c) Three (3) passport size color pictures of herself, bearing her official signature,
as ANNEX E;
d) Three (3) legible impression of her notarial seal along with three (3)
specimens of her official signature, as ANNEX F.
6. A copy of the Petition was posted in a conscious place particularly at the entrance of the
Hall of Justice. A copy published in a newspaper of general circulation.
7. The Petitioner intends to apply for a commission for Dumaguete City and the
Municipalities of Bacong, Dauin Zamboanguita, Siaton, Valencia, Sibulan, and all of the
Province of Negros Oriental for the years 2012 and 2013.

Wherefore, the Petitioner respectfully prays that the Honorable Court grant has notarial
commission for Dumaguete City and all other municipalities in Negros Oriental for the year
2015 and 2016, under the permission of Section II of the Notarial Law of 2004.
November 11, 2015, Dumaguete City, Philippines.

__________________________
Petitioner
Room 101, EBT Bldg., Rizal Boulevard Dumaguete City
Telephone Nos. 225-1111, 225-2222
IBP No. 1728273, 11/14, 2014 Dumaguete City
PTR No. 0037843784, 73483748 Dumaguete City
Attorneys Roll No. 283473
MCLE Compliance No 11-00909098

VERIFICATION AND CERTIFICATION OF

NON-FORUM SHOPPING
I, ______________________________, of legal age, Filipino, married & a resident of
Dumaguete City, Negros Oriental, on oath hereby depose and say that:
1. I am the petitioner in the above-mentioned petition; I have read the foregoing petition and
that the allegation therein are true and correct of my own personal knowledge and belief;
2. I hereby certify that I have not therefore commence any action or filed any claim
involving the same issues in any court, tribunal or quasi-judicial agency and, to the best
of my knowledge, no such other action or claim is pending therein, and I should
thereafter learn that the same or similar action or claim has been filed or is pending, I
shall report that fact within five ( 5 ) days therefrom to the Honorable Court.

IN WITNESS WHEREOF, I have hereunto affix my signature this _________ day of

_________ at the City of Dumaguete, Philippines.

__________________________________
Petitioner

SUBSCRIBED AND SWORN to before me this _____ day of _________ at the City of
Dumaguete, Philippines affiant showing her Attorneys Roll No. 38822.

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