Jurat- Affiant is personally known to the notary public; blind, illiterate or physically

impaired to affix his signature to the document; with credible witnesses who are not
privy to the affidavit

THUMBARK
(Name of Affiant)

*Affiant (name of affiant) affixed his Thumbmark in the presence of the following witnesses: (state name
and address of the two witnesses)

1. ______________________________________________________________________
2. ______________________________________________________________________

SUBSCRIBED AND SWORN TO before me in ________, this ____ day of ________ by ( name of
affiant), personally known to me to be the same person who personally affixed his Thumbmark in the
foregoing affidavit before me and in the presence of the two (2) witnesses whose signatures appear
below his thumb signature, who are not privy to this affidavit, and acknowledged before me that he
executed the same.

The undersigned further certify that the contents of the affidavit was explained by me in (English
or Filipino), a Language known and understood by the affiant, he being (state whether blind, illiterate, or
physically impaired to sign) and appears to have understood the contents thereof.

(Signature and Seal of the Notary Public)

NOTARY PUBLIC

A. M. No/Comm. No._____________
Date and Place Issued
Commission expires on Dec. 31, ____
Roll of Attorney Number
IBP No., date and place issued
PTR No date and place issued
MCLE Comp./Exemp. No.
Date issued and validity
Office Address; telephone number
Fax No.______; email address

Doc. No. ______:

Page No. ______:
Book No. ______:
Series of 20_____.