JURAT- Legal Forms

1. JURAT

JURAT

SUBSCRIBED AND SWORN to before me, this 15th day of March, 2007 in the City of Quezon,
affiant exhibiting before me his Community Tax Certificate No. 123456, issued at Quezon City
on March 1, 2007.

ATTY. JANE ABLAZA

NOTARY PUBLIC for Quezon City

15 Carnation St., DRJVillage, Novaliches, Q.C.

Until Dec. 31, 2007

Roll No. 0001

P.T.R. No. 0002, 12/31/2007, Manila.

IBP No. 0003, 12/31/2007, Manila.

MCLE Compliance No. 1234

Serial No. of Commission: 07-11111

Doc. No. 5;

Page No. 6;

Book No. I;

Series of 2007

REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF ______) SS.
ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _____________,
personally appeared _____________ with Community Tax Certificate No. _____________
issued on _____________ at _____________ (and Tax Identification No. (T.I.N.)
_____________), known to me and to me known to be the same person who executed the
foregoing instrument which (he/she) acknowledged to me as (his/her) free and voluntary act and
deed, consisting of only ______ (____) page/s, including this page in which this
Acknowledgement is written, duly signed by (him/her) and (his/her) 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 ______;

COPY CERTIFICATION

I, ATTY. MAGDALENA R. LEPITEN, A NOTARY PUBLIC, IN THE CITY AND PROVINCE OF

CEBU, IS PRESENTED WITH AN INSTRUMENT OR DOCUMENT THAT IS NEITHER A
VITAL RECORD, A PUBLIC RECORD, NOR PUBLICLY RECORDABLE; THAT I CAUSED OR
SUPERVISED THE COPYING OF THE INSTRUMENT OR DOCUMENT; THAT I HAVE
COMPARED THE INSTRUMENT OR DOCUMENT WITH THE COPY; AND THAT I CERTIFY,
AFTER HAVING DETERMINED, THAT THIS COPY IS ACCURATE AND COMPLETE
COMPARED WITH THE ORIGINAL INSTRUMENT OR DOCUMENT COPIED.

DATE: ___________________________

Doc. No. ATTY. MAGDALENA R. LEPITEN

Page No. Notary Public for Cebu City and Cebu Province
Book No. Notarial Commission No. 280
Series of 2013 Until December 31, 2013
21-F Don Pedro Rodriguez St.,
Capitol Site, Cebu City Philippines
Roll No. 36617
PTR No 137365, January 3, 2013, Cebu City
IBP No. 567022 Lifetime
Cebu City