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REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT
FIRST JUDICIAL REGION
BRANCH ___
___________, ILOCOS SUR

RE: PETITION FOR RENEWAL OF

COMMISSION AS NOTARY PUBLIC
FOR AND IN THE PROVINCE OF ILOCOS
SUR UNDER THE TERRITORIAL JURIS-
DICTION OF THE HONORABLE COURT

APPLICATION NO. _______

ATTY. __________,
Petitioner.
x-------------------------x

PETITION

COMES NOW, the undersigned petitioner and unto this Honorable

Court, most respectfully states:

1. That he is ___ years of age, having been born on __________ at

______, Ilocos Sur, with mobile number __________, PTR No.
________ issued on _______ at __, Ilocos Sur, and Roll of Attorneys
No. _______;

2. That he is a citizen of the Philippines, and a permanent resident of

Brgy. _________, Ilocos Sur, Philippines, since birth;

3. That he is a member of the Philippine Bar and is a member of good

standing as shown by a Certification from the Office of the Bar
Confidant, Supreme Court of the Philippines. The Certificates of
Membership and Good Standing from the Office of the Bar
Confidant are hereto attached as Annexes “A” and “A-1”,
respectively. The Certificate of Membership and Good Standing
from the IBP Ilocos Sur Chapter is hereto attached as Annex “B”;

4. That he has never been convicted nor charged of any crime involving
moral turpitude. That he has no criminal or derogatory record as
shown by his NBI Clearance, hereto attached as Annex “C”;
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5. That he has paid the filing fees for this application/petition as shown
by the Official Receipt;

6. That attached are the three (3) passport size colored picture and
marked collectively as Annex “D”;

7. That attached herewith as Annex “E” are specimens of his

signature, and the image or impression of the seal of the
undersigned as Annex “F”;

8. That he has not been commissioned as Notary Public anywhere

outside the jurisdiction of this Honorable Court;

9. That this petition is for the renewal of his Commission which will
expire on _________, and is accompanied by a Certification from this
Court that he has faithfully submitted his notarial reports.

WHEREFORE, premises considered, the undersigned respectfully

prays that his Commission be renewed as Notary Public for and in the
province of Ilocos Sur within the territorial jurisdiction of the Honorable
Court.

Other reliefs, just and equitable under the premises are likewise
prayed for.

___________, Ilocos Sur. _________.

MBS
Petitioner

VERIFICATION AND CERTIFICATION

OF NON-FORUM SHOPPING

I, _______, of legal age, Filipino, married, and a resident of Brgy.

_________, Ilocos Sur, after having been sworn in accordance with law,
hereby depose and state, THAT:
That I am the petitioner that prepared the petition, and that I hereby
declare that all the allegations contained therein are true and correct
based on my personal knowledge and on authentic record.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ at

______, Ilocos Sur.
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Petitioner/Affiant

SUBSCRIBED AND SWORN TO Before me, this ____________ at

_______, Ilocos Sur, Philippines.