Sample Form of ACKNOWLEDGMENT

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF _______________)
CITY/MUNICIPALITY OF _______) S.S.
BEFORE ME, a NOTARY PUBLIC for and in the above jurisdiction, this ___ day of _____,
2011, personally appeared the following persons
NAME
____________
____________

IDENTIFICATION
____________
____________

DATE AND PLACE

OF ISSUANCE
_______________
_______________

Known to me to be the same persons who executed the foregoing instrument and
they acknowledged to me that the same is their own free and voluntary act and deed [12]
and of the corporations herein represented.
This instrument refers to a (title of document) and consists of ___ pages including the
page on which this acknowledgment is written and signed by the parties and their
instrumental witnesses on each and every page thereof.
WITNESS MY HAND AND SEAL on the date and at the place above written.

issue
issue

BBB
NOTARY PUBLIC- Makati City
Appointment No. ____
Until December 31, 2010
Roll no. ____
PTR no. ____, date of issue, place of
IBP no. _____, date of issue, place of
Office Address:
Email:
Contact Number:

Doc. No._____;
Page No. ____;
Book No.____;
Series of 2011.