notarial form

Judicial Form No. 143, as amended Pormulariong Panghukuman Blg. 143

____ NOTA NOTARIA RIAL L REGISTE REGISTERED RED

of MR. MR. ____________ __________________ ___________ _____

Rehistro Notaryal ni G.

______ _________ ______ ______ ______ ______ _____ __

Sa nombramien iento na gina inawa noong ______________ _____ TITLE/DESCRIPTION OF INSTRUMENT

, Philippin Philippines, es, for the year year

ng ________________________________Pilipinas, para sa taon

Unde Under r appo appoin intm tmen ent t made ade on the the ENTRY  NUMBER

of ___________ _________________ ___________ ______ _

Page No. ____ Book No.

NAME & ADDRESSES O PARTIES

and and expir expiring ing De Dece cem mbe ber r 31, 31, 201_ 201__ _ na magtatapos sa Disy isyembre 31,

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 HEREBY CERTIFY

that during the past week ______ instrument instrument were

Pinatunayan nayan na noong noong nakaraang nakaraang linggo

______ ______ 

ang mga kasulatan kasulatan

sworn to

before me

pinanump pinanumpaan

sa harapam harapam ko

acknowledge tinanggap DATE ___________________________________________ Petsa

____________________  Notary Public

Whether acknowledgement, oath, jurat, signature witnessing or copy certification Publiko

Notaryo