REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

_____________ JUDICIAL REGION
_____________

IN RE: PETITION FOR COMMISSION

AS NOTARY PUBLIC
_____________________________

Petitioner,
X- - - - - - - - - - - - - - - - - - - - - - - - - -- - -X

PETITION

PETITIONER, ________________________, unto this Honorable Court,

most respectfully states that:

1. She/He is of legal age and a Filipino citizen;

2. She/He is presently residing at

_________________________ and residing therein since _________ and
maintains a regular place of work in the City of __________;

3. She/He is holding her/his private law office at

____________________________________________________________
__;

4. She/He has satisfactorily completed the required course

in law at _________________ in _________ (date of graduation);

5. She/He has passed the _______ Bar Examinations and

admitted to practice law in the Philippines on _________________. Copy
of the Certificate of Bar Membership is herewith attached as Annex A and
made an integral part of this petition;
6. She/He is a member of the Philippine Bar in good
standing with Clearances from the Office of the Bar Confidant of the
Supreme Court and the Integrated Bar of the Philippines. Copy of said
clearances are herewith attached as Annex B and Annex C, respectively
and made an integral part of this petition;

7. The undersigned has not been charged nor convicted in

the first instance of any crime involving Moral Turpitude;

8. She/He desires to be commissioned as Notary Public for

and in Municipality/City of ____________ and possesses all the
qualifications and none of the disqualifications for said office;

9. In compliance to the requirements of the Honorable

Court for Notarial Commission, attached hereto are the following annexes
and made an integral part of this petition:

a. Three Specimen of his/her Official Signature as Annex D;

b. Picture of Desk, Sketch of Prospective Office and sketch of the location
of the office as Annex E, E-1 and E-2;
c. 3 pcs. 2X2 ID picture as Annex F;
d. Copy of IBP Membership Payment Receipt as Annex G;
e. Copy of PTR Receipt as Annex H.

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed of this

Honorable Court that:

1. The Petition for Commission as Notary Public filed by the

undersigned be acted favorably; and

2. Petitioner be commissioned as a Notary Public in the

Municipality/City of ______________.

Date ____________, Municipality/ City of ____________.

 __________________________
Petitioner
Address ______________________
Contact No.___________________
E-Mail Address ________________
Roll No. ______
IBP No. ______ /Date and Place of Issue
PTR No. _____ /Date and Place of Issue
MCLE Certificate of Compliance No. ____

VERIFICATION and CERTIFICATION AGAINST FORUM SHOPPING

I, ___________________, under oath, depose and state that:

1. I am the petitioner in the above-entitled petition;

2. I have caused the preparation of the foregoing Petition;

3. The allegations therein are true and correct based on my personal

knowledge and authentic records;

4. To the best of my knowledge, there are no other pending petitions of

the same nature before any court, tribunal or quasi-judicial agency; and

5. Should I thereafter learn of any similar case pending before any other
court, tribunal or quasi-judicial agency, I shall promptly notify this court
within five (5) days from discovery.

____________________________
(Name of the Petitioner)

JURAT
SUBSCRIBED AND SWORN to before me in the _________ on this day of
_________ 20___, affiant exhibiting before me her/his (Government-
issued Identification Card No. ) issued on _________ in ___________.

NOTARY PUBLIC

Doc. No. ______;

Page No.______;
Book No.______;
Series of ______.