Legal Forms-

Notarial Certificates
and Affidavits
Daniel Lising MD LLM
 Notarial Certificates
• Jurat

• SUBSCRIBED AND SWORN to before me this 23rd day of April 2021 at Quezon City, affiant exhibiting her
valid ID. Driver’s License No. N02-96-321213 valid until June 29,2026.
•
•
• Doc. No. _____;
• Page No._____; NOTARY PUBLIC Book
No. _____;
 Notarial Certificates

• Acknowledgement
• is a statutory act such that only those
instruments that are required by law to be
acknowledged shall be acknowledged;
• it is also a personal act such that it cannot be
acknowledged by a person other than the one
who executed it.
 Forms that require an
Acknowledgement

• Deeds
• Mortgages
• Leases
• Conveyances
 Contents
Title of the notarial act
Place of execution
Date
Name of person acknowledging the
document (as well as name/s of the
entity/ies being represented, if such is the
case)
Competent evidence of identity presented
Date and place of issue of the competent
evidence of identity presented
Acknowledgment made to the notary
public that it is the person’s voluntary act
and deed
Type of document executed and number of
pages
Notarial certificate
Identity of notary public
Details of the notarial register
If executed in a representative capacity, a
statement to that effect
•
• ACKNOWLEDGEMENT
•
• Republic of the Philippines )
• ) S.S
•
• BEFORE ME, personally appeared:
•
• Name ID Number Date/Place Issued
•
•
•
•
• Known to me and to me known to be the same persons who executed the foregoing instrument and
acknowledged to me that the same is their free and voluntary act and deed.
•
• WITNESS MY HAND AND SEAL, on the date and place first above written.
•
•
• Notary Public
• Doc. No.______;
• Page No. ______;
• Book No.______;
• Series of 20___.
•
Affidavits
 Definition

• a written statement of fact voluntarily made by

an affiant under an oath or affirmation which is
administered by a person who is authorized to
do so by law.
 Parts of an affidavit

• the venue of execution,

• title,
• person(s) bona fides,
• the oath,
• statement,
• the signature and
• the jurat
REPUBLIC OF THE PHILIPPINES)
Province of____________________) S.S.
City/Municipality of_____________)
x---------------------------------------x

AFFIDAVIT OF DISCREPANCY ON NAME

I, ______________(name of affiant)__________________, Filipino, of

legal age, [single]/[married to ___________(name of
spouse)_______], and a resident of ___________(address of
affiant)____________, after having been duly sworn in accordance
with law, hereby depose and state:

1. That on _____(date)________, I was issued a Philippine

Passport with passport number _____________ in which my true
First Name _____(Correct Name)____ was stated;

2. That before the expiration of the aforementioned passport on

_____(date)________, I had applied with Philippine Embassy in
_____________ for the issuance of a new passport and on
_____(date)________,

4. I was issued a new Philippine passport with passport no.

_____________________;

5. However, in the said new passport my First Name had been

erroneously misspelled as _____(Misspelled Name)____;

4. That I execute this Affidavit of Discrepancy to attest to the truth

of the foregoing facts and to explain the discrepancy in my
Philippine Passport with regards my First Name.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________, at _____________, Philippines.

____________(signature)___________
Affiant’s Name

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________
20___. Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government
Agency)______ on ___(date)__ at ________(place)_________, bearing his
photograph and signature, known to me as the same person who personally
REPUBLIC OF THE PHILIPPINES )
Province of ____________________ ) S.S.
City/Municipality of ______________ )
x---------------------------------------x

AFFIDAVIT OF RECONCILIATION OF BIRTH DATA

I, ________________(name of affiant)____________, Filipino, of legal

age, [single]/[married to _________(name of spouse)_________], and
a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance
with law, hereby depose and state:

1. That I am the [son]/[daughter] of the couple Mr.

_________(name of father)___________ and Mrs.
___________(name of mother)______________ and of and I
was born on __________(date of birth)__________ at
________________(place of birth)________________;

2. That in the birth certificate which I obtained only recently, my

[first name]/[middle name]/[family name] is spelled as
“_______________” instead of “_______________” to which I
have been used to as in my school records, SSS, BIR and other
public documents;

3. That a copy of said birth certificate which indicated my [first

name]/[middle name]/[family name] as
“____________________” is hereto attached for reference. See
Annex A;

4. That a copies of my school records, SSS/GSIS, BIR and other

public documents which indicated my [first name]/[middle
name]/[family name] as “____________________” is hereto
attached for reference. See Annex B, C, D, and E;

5. That the names belong to one and the same person, the
undersigned affiant herein;

6. That I am executing this affidavit in order to attest to the truth

of foregoing circumstances and for the purpose of setting the
records straight and declaring that _________________ and
_________________ refer to one and the same person.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____th day of __________, 20__ , Philippines.

_________________________________
REPUBLIC OF THE PHILIPPINES )
Province of____________________) S.S.
City/Municipality of______________)
x---------------------------------------x

AFFIDAVIT OF PUBLICATION

I, ________________(name of affiant)____________, Filipino, of legal

age, [single]/[married to _________(name of spouse)_________], and
a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance
with law, hereby depose and state:

1. That I am the Classified Ads Manager of the ________(name

of newspaper)_____________, publisher of the which is being
published daily in English, of general circulation with editorial and
business address at __________________________________;

2. That at the order of _____________, Extrajudicial Settlement

of Estate of the late _____________________ dated
________________ was published in this newspaper in its
_________ issue(s) of __________________;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___th day of __________, 20___ at _____________, Philippines.

_________________________________

(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________
20___. Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government
Agency)______ on ___(date)__ at ________(place)_________, bearing his
photograph and signature, known to me as the same person who personally
signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.

Atty _______________________________________
Notary Public
Doc. No. ____ Commission Serial No. __________________
Page No. ____ Notary Public for ____(Province/City)________
Book No. ____ Until December 31, 20__
Series of 20__ Office: _________(address)_______________
Roll No. __________
IBP Lifetime Roll No. ________; __/__/__ ; (Province)
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__
 Affidavit - One and the Same Person

REPUBLIC OF THE PHILIPPINES )

Province of____________________) S.S.
City/Municipality of______________)
x---------------------------------------x

JOINT AFFIDAVIT

We, ______(affiant #1)_______ and ______(affiant #2)_______, both

Filipinos, of legal ages, and residents of
________________________________ and
_______________________________, respectively, having been
duly sworn in accordance with law, hereby depose and state:

1. That we have personally known the person of _____MARIA

CLARA_____ for a long period of time having been her long time
friend;

2. That we know for a fact that the person by the name of

"___MARIA CLARA____" appearing in some documents,
records, and specifically in her Certificate of Live Birth AND the
name "_______MARIA CLORO______" as appearing in the
records of __________(example:
GSIS)____________________, refer to one and the same
person and that her true and correct name is _____MARIA
CLARA_____;

3. As such, we execute this Affidavit or attest to the truth of the

foregoing facts and for whatever legal purpose that this Affidavit
may serve.

IN WITNESS WHEREOF, we have set our hands this _____________,

at _____________, Philippines.

___________________
_____________________
AFFIANT #1 AFFIANT #2

SUBSCRIBED AND SWORN to before me this __th day of _____________,

20___ in Pasig City, personally appeared ______Affiant 1_________________
exhibiting to me his Passport No. _____________ issued on ________________
REPUBLIC OF THE PHILIPPINES)
Province of____________________) S.S.
City/Municipality of_____________)
x---------------------------------------x

AFFIDAVIT OF NON-OPERATION OF A CORPORATION

I, ________________(name of affiant)____________, Filipino, of legal

age, [single]/[married to _________(name of spouse)_________], and
a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance
with law, hereby depose and state:

1. That I am the President and Chairman of the Board of

____________________________________, a corporation
duly organized and existing under the laws of the Philippines with
principal office at
________________________________________;

2. That said corporation was incorporated on

__________________ but has not yet commenced its operation
because of
_____________(reasons)_____________________;

3. That the stockholders and directors of the corporation are

contemplating on reviving its operation in the near future when
the some business opportunities come;

4. That this affidavit is being executed in order to attest to the

truth of the foregoing circumstances and for the purpose of
complying with the reportorial requirements of the Securities and
Exchange Commission.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____th day of ____________ 20___ at ____________, Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________
20___. Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government
Agency)______ on ___(date)__ at ________(place)_________, bearing his
REPUBLIC OF THE PHILIPPINES)
QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, SIR ARLAN JEFFERSON R. PEÑA, Filipino citizen, of legal age, and a

resident of Lot 11 Blk 2. Gwapo Maganda Homes, Brgy. Culiat, Quezon City, Metro
Manila 1128, after having sworn to in accordance with law do hereby depose and state
THAT:

1. I am a holder of a valid Driver’s License with License No. D01-00-637821

issued by the Land Transportation Office expiring on August 21, 2022;

2. Sometime in January 2021, I traveled to Boracay via Cebu Pacific Airline to

visit my family therein but due to limited baggage allowance, I left and entrusted
some of my belongings to a friend who is also an authorized sales officer of the
Cebu Pacific;

3. Upon my return, I was informed by my friend that my luggage had been

delivered by mistake due to the similarity of brand and color with another passenger
whose identity cannot be determined until now;

4. My Driver’s License and other necessary documents were inside that luggage
and I agreed to the offer of the Airline to accept compensation because the luggage
can no longer be located by them;

5. I have exerted diligent effort to find said baggage as well. However, up to

present time, the same has not yet been retrieved, thus, considered misplaced and
lost now;

6. I have executed this affidavit for the reissuance and/or retrieval of my Driver’s
license and to attest to the veracity and truthfulness of the foregoing statement and
for whatever legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st day of

April 2021 in Quezon City, Philippines.

SIR ARLAN JEFFERSON R. PEÑA

Affiant

SUBSCRIBED AND SWORN to before me this 21st day of April 2021 in Quezon
City, Philippines, affiant is exhibiting to me his Tax Identification Card with No. 717-753-
878-000 as competent proof of his identity.

ATTY. LANUEL M. RAMORAN

NOTARY PUBLIC FOR QUEZON CITY
Doc. No. 55 ; Adm. Matter No. NP 1-75 (2021-2022)
Page No. 10 ; Roll No. 77777. MCLE Compliance VI-002364
Book No. XV ; PTR No. 125623 01/03/2020 Quezon City
Series of 2021. IBP No. 1059863 01/03/2020 Quezon City
Commission expires on December 2022
 Republic of the Philippines )

City of Caloocan ) S.S.

AFFIDAVIT OF LOSS
OF PASSPORT

I, JUAN DELA CRUZ, of legal age, Filipino, married, and a resident of #123
Ilang-Ilang St., Malaria, Caloocan after having been duly sworn to in accordance
with law, hereby depose and state THAT:

1) On April, 2020 I was issued a Philippine Passport by the Department

of Foreign Affairs, however, I can no longer recall the Passport
Number of the said Passport;

2) Sometime around February 2021, I noted that the said passport was
missing;

3) To my knowledge my passport was lost when our family home was

subjected to a renovation;

4) I took great pains to look for the said passport but to no avail;

5) Despite diligent search and efforts to locate the said passport, I could
not find the same such that I now believe that it is now lost beyond
recovery;

6) I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support the application for the issuance of new one
in lieu if the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this April 24, 2021
at Caloocan City, Philippines.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO before me this 24 th of April 2021 in

Caloocan, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. __________;

Page No.__________;
Book No.__________;
Series of 2021.
• Republic of the Philippines)
• City of Manila )
•
• AFFIDAVIT OF ADMISSION OF PATERNITY
•
• I, JUAN T. DELA CRUZ, of legal age, a Filipino Citizen, and with address at BLK 1 LOT 1 CAYCO STREET, MANILA, after having duly sworn to in accordance with law, do hereby, depose
and state as follows:
•
•
1. I am the biological father of PEDRO M. SANTOS;
•
1. PEDRO M. SANTOS was born on 24 August 2020 in Manila City;
•
1. The biological mother of PEDRO M. SANTOS is MARIA M. SANTOS;
•
1. At the time of the birth of PEDRO M. SANTOS, I was not legally married to his biological mother MARIA M. SANTOS;
•
1. The facts of birth of PEDRO M. SANTOS were registered at the City Civil Registrar of Manila with Registry Number 123-45678-9;
•
1. I hereby admit under oath my paternity with PEDRO M. SANTOS and such acknowledgment is reflected at the back of his Certificate of Live Birth;
•
1. I am executing this affidavit to attest to the truth of the foregoing facts and for whatever legal purpose it may serve.
•
• IN WITNESS WHEREOF, I hereby affix my signature this 25th day of April, 2021 in the City of Manila.
•
• JUAN T. DELA CRUZ
• Affiant
•
• SUBSCRIBED AND SWORN to before me this 25th day of April, 2021 at the City of Manila. Affiant exhibited to me his Passport No. EC157862 issued at Paranaque on 21 March 2020, as
competent proof of his identity.
•
• Doc No._____;
• Page No.____;
• Book No.____;
• Series of 2021.
REPUBLIC OF THE PHILIPPINES)
QUEZON CITY )S.S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, KRISTOFFER KARL R. PELAYO, of legal age, Filipino, and

presently residing at No. 101, Samaka Village, West Fairview, Quezon
City, and AURABEL JOI R. DYSANGCO, also of legal age, Filipino,
and presently residing at Victoria Towers, Timog Avenue corner
Panay Avenue, Paligsahan, Quezon City, after having been sworn to
in accordance with law hereby depose and state that;

1. We personally know CHARLENE A. BUENCONSEJO, being

our close friend for more than 15 years;

2. We declare and affirm that she was born at Dalaguete, Province

of Cebu, Philippines on 25 August 1991;

3. Her name as appearing in her Birth Certificate is CHARLENE A.

BUENCONSEJO, whereas her records in Philhealth showed
CHARLYN A. BUENCONSEJO;

4. She has been using CHARLENE A. BUENCONSEJO in all of

her documents and transactions, as it is the correct spelling of
her name;

5. We are not related to her either by consanguinity or affinity, and

have no direct or indirect interest in whatever legal purpose this
affidavit may serve;

6. We are executing this affidavit to attest the truthfulness of the

foregoing facts, and to establish that CHARLENE A.
BUENCONSEJO and CHARLYN A. BUENCONSEJO refer to
the same person.

IN WITNESS WHEREOF, we have hereunto affixed our

signatures this 23rd day of April 2021 in Quezon City, Philippines.
 • Republic of the Philippines )
Quezon City ) S.S.
•
•
• AFFIDAVIT TO USE THE SURNAME OF FATHER
•
• I, GERALD A. BAUTISTA, of legal age, Filipino citizen, and with residence address at No. 52 Brgy. Kanluran, Sta. Rosa City, under oath, depose and state:
•
1. That I am the biological father of CATHERINE JOY;
•
1. That my abovenamed daughter was born on June 13, 2013 at Calamba City, Laguna;
•
1. That the facts of birth of my daughter were duly registered at the Office of the Civil Registrar of Calamba City, Laguna;
•
1. That CATHERINE JOY’s mother, ELEONOR AQUINO GOMEZ, and I subsequently contracted marriage only on December 4, 2014 at Calamba City, Laguna. A
copy of our Certificate of Marriage is attached herewith as Annex A;
•
1. At the time my daughter was born, her mother and I have no legal impediment to marry each other;
•
1. That being the father of CATHERINE JOY, I hereby acknowledge and recognize her as my child and legal heir;
•
1. That I am allowing my child, CATHERINE JOY, to use my surname, and the same to appear in her Certificate of Live Birth; and
•
1. That I execute this affidavit to attest to the truth of the above facts and for other purposes it may serve.
•
• IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of April 2021 at Quezon City, Philippines.
•
• GERALD A. BAUTISTA
• Affiant
•
•
•
• SUBSCRIBED AND SWORN to before me this 21st day of April 2021 in Quezon City, Philippines, affiant exhibiting to me his Postal ID with PRN E35200003159 P
as competent proof of his identity.
•
• Doc. No: ________;
• Page No: ________;
• Book No: ________;
• Series of 2021.
• REPUBLIC OF THE PHILIPPINES )
• QUEZON CITY )S.S.
• x----------------------------------------------x
•
•
• AFFIDAVIT OF SUPPORT
•
•
• I Fatima P. Yatna of legal age, Filipino citizen, single and with residence at No. 12 Willow, Ferndale Homes, Pasong Tamo, Quezon City, after being
duly sworn to in accordance with law, hereby depose and state that:
•
1. I am the aunt/guardian of Dastine M. Tabana, 5 years of age;
•
1. Said child has been under my care and custody while her parents are looking for greener pasteur in the province of Mindanao and eventually resettle thereat;
•
1. Presently, said child is wholly dependent on me for financial support of her sustenance and medical needs.
•
1. I’ am executing this Affidavit to attest to the truth of the foregoing and for whatever legal purpose this may serve.
•

• IN WITNESS WHEREOF, I have affixed my signature this 23rd day of April 2021 at Quezon City, Philippines.
•
•
•
• Fatima P. Yatna
Affiant
•
• SUBSCRIBED AND SWORN to before me this 23rd day of April 2021 at Quezon City, affiant exhibiting her valid ID. Driver’s License No. N02-96-321213 valid
until June 29,2026.
•
•
• Doc. No. _____;
• Page No._____; NOTARY PUBLIC Book No. _____;

• Series of 2021
REPUBLIC OF THE PHILIPPINES )
CITY OF IMUS, CAVITE ) S.S

AFFIDAVIT OF DISCREPANCY IN ENTRY OF HOSPITAL

RECORDS

I, Jose Dela Cruz, of legal age, Filipino and with residence address at
No. 0123 Neogaf Compound, Pinagbuhatan, Imus City, Cavite, Philippines,
under oath state that:
1. My name is Jose Dela Cruz as stated and registered in my birth
certificate issued by the office of the Civil Registry of the Municipal
Civil Registrar, Ramon, Isabela. A copy of my birth certificate is
hereby attached as Annex “A”;
2. In the hospital records, my name was erroneously entered as Joe Dela
Cruz;
3. The name Jose Dela Cruz and Joe Dela Cruz refer to one and the same
person, the herein affiant;
4. I am executing this Affidavit to correct the entry of my name in the
hospital records and for legal purposes.
IN WITNESS WHEREOF, I hereunto affix my signature this 24th
day of April 2021 at Cavite City.

Jose Dela Cruz

Affiant

SUBSCRIBED AND SWORN to before me this 24th of April 2021 at

Imus City, Cavite, affiant exhibiting to me his Philippine Passport with
Passport no. EB123456

Andie Xercez S. Millo

NOTARY PUBLIC
Until December 31, 2022
Serial No. of Commission: NP-212
Place of Commission: Imus City
Office Address: 12th Street Dayo, Imus City
Roll of Attorney’s No. 12345
Book no. 2 IBP Lifetime No. 54321
Page no. 3
Doc. no. 4
PTR No. 09876, at Imus City on Jan. 6, 2021
Series of 2021 MCLE No. VI-0008022 / April 24, 2018
 6.) I am from a religious family. My parents named me after the most
Republic of the Philippines famous female saints that my name has become extremely lengthy
Local Civil Registry Office and difficult to write. My first name APOLLONIA AGNES
Quezon City, Philippines ANYSIA QUITERIA EMMELIA FABIOLA PEREZ consists
of 47 letters.

Republic of the Philippines) 7.) I submit the following documents to support this petition:
Quezon City, Metro Manila) ss Petition No.
a. Birth Certificate to be recorded

b. Affidavit of publication
PETITION FOR CHANGE OF FIRST NAME
c. NBI and Police Clearance

d. Diploma
I, APOLLONIA AGNES ANYSIA QUITERIA EMMELIA FABIOLA
PEREZ, of legal age, Filipino, and a resident of 21-A Malamig St., Techer’s Village e. Certificate of Employment, Valid ID, Service Record, Marriage
East, Quezon City, Metro Manila, having been duly sworn to in accordance with Certificate, and Birth Certificate of Children
law, hereby declare that:
8.) I have not filed any similar petition and that, to the best of my
1.) I am the petitioner seeking the change of first name in: knowledge, no other similar petition is pending with any LCRO,
Court, or Philippine Consulate;
a. My Certificate of Live Birth;
9.) I have no pending criminal, civil, or administrative case in any
2.) I was born on March 13, 1969 at Quezon City, Metro Manila, court or any quasi-judicial body; and
Philippines;
10.) I am filing this petition at the LCRO of Quezon City, Metro Manila
3.) The birth was recorded under registry number 1968; in accordance with R.A. 9048 and its implementing rules and
regulations.
4.) The first name to be changed is from “APOLLONIA AGNES
ANYSIA QUITERIA EMMELIA FABIOLA PEREZ” to
“AGNES”;
APOLLONIA AGNES ANYSIA
5.) The ground/s for filing this petition is the following: QUITERIA EMMELIA FABIOLA
PEREZ
a. The name is ridiculous, dishonorable, or extremely difficult to Signature over printed name of Petitioner
write or pronounce
Thank you for your
attention!