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That I, JEFFREY R. ORTIZ LUIS, Filipino, of legal age, a resident of San Fernandao
Sur, Cabiao Nueva Ecija, is the lawful owner of a motor vehicle which is more particularly
described as follows:
_____________________________ ______________________________
ACKNOWLEDGEMENT
Republic of the Philippines )
Municipality of Cabiao ) S.s
Province of Nueva Ecija )
Before me a notary public for and in the Municipality of Cabiao, this ______ day of
__________, 2018 appeared ______________________with his
__________________________ issued at _____________________ on
___________________,2018 and claims to be the same person who executed the foregoing
instrument and acknowledge to me that the same is his own free act and voluntary deed.
WITNESS MY HAND AND NOTARIAL SEAL on the date and place above-written.
Notary Public
Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.