Judicial Form No.
143, as amended
NOTARIAL REGISTERED of MR. _______________________
Page No. ____ Book No. ____
of _______________________, Philippines, for the year
Rehistro Notaryal ni G.
ng ________________________________Pilipinas, para sa taon
Under appointment made on the _______________________
and expiring December 31, 201__
Sa nombramiento na ginawa noong ________________
na magtatapos sa Disyembre 31,
Pormulariong Panghukuman Blg. 143
ENTRY
NUMBER
TITLE/DESCRIPTION
OF INSTRUMENT
NAME & ADDRESSES
O PARTIES
NAME & ADDRESSES
OF WITNESSES
COMPETENT EVIDENCE
OF IDENTITY
DATE & TIME OF
NOTARIZATION
TYPE OF
NOTARIAL
ACT
FEES &
O.R. NO.
OTHER PLACE OF
NOTARIZATION OTHER
THAN OFFICE OF NOTARY
PUBLIC AND/OR
REMARKS
executed
isinagawa
HEREBY CERTIFY that during the past week ______
Pinatunayan na noong nakaraang linggo
______
______
instrument were
ang mga kasulatan
sworn to
before me
pinanumpaan
sa harapam ko
acknowledge
tinanggap
DATE ___________________________________________
Petsa
Whether acknowledgement, oath, jurat, signature witnessing or copy certification
____________________
Notary Public
Notaryo Publiko