Acknowledgment of Source: Legal Forms (Practical Exercises in Pleading and Conveyancing) Ruben E. Agpalo, 2006 Rex Bookstore, C.M.

Recto, Manila

Republic of the Philippines __ Judicial Region Branch __, _______

Re: Petition for Appointment As Notary Public in ________

__________________________ Petitioner.

x--------------------------------------------x PETITION

PETITIONER, _________________, respectfully alleges: 1. That he is over 21 years, a citizen of the Philippines, and a resident of ____________________; 2. That he is a member of the Philippine Bar, having passed the bar examinations given in ____, and admitted to the practice of law in the year _____; 3. That he possesses all the qualifications and none of the disqualifications for the office of the Notary Public; 4. That he has never been convicted of any crime implying moral turpitude; 5. That attached thereto, in a separate sheet of paper but as part of this petition, are three (3) specimens of petitioners official signature and true impressions of his dry seal.

NAME DATE PLACE

VERIFICATION I, ___________, of legal age and with residence_______________________, after having been duly sworn, depose and say:

1. That I am the petitioner in the above entitled petition. 2. That I have caused the preparation by my counsel of said petition. 3. That I have read the allegations therein contained, and that the same are true and correct of my personal knowledge or based on authentic records. Witness my hand this __th day of ______ 20___ at Naga City, Philippines.

__________________ Affiant

JURAT SUBSCRIBED AND SWORN to before me, a notary public in and for Naga City, this __th day of _______ 2012 at Naga City, Philippine, affiant appearing before me with his __ No. ______ issued on _________, 2012 at ___________ and presenting to me a document entitled Re: Petition for Appointment As Notary Public in ___________, affiant being known to me personally as he is a friend, and who signed said document in my presence and sworn as to said document that he understood the contents thereof and that the same was his free and voluntary act and deed.

________________________________ Notary Public Until December 31, 20__ Roll of Attorneys No. PTR No. IBP No. MCLE No.

Doc. No. Page No. Book No. Series of 20__