A C K N O W L E D G M E N T

REPUBLIC OF THE PHILIPPINES )

) SS.

At the above stated locality, on this ____ day of __________________, before me

personally appeared:

Name Competent Evidence of Identity Issued on/Valid Until

known to me and to me known to be the same persons who executed the foregoing instrument
and who acknowledged before me that theirs signatures on the instrument were voluntarily
affixed by them for the purposes stated therein, and who declared to me that the said instrument
is their free and voluntary act and deed and that of the corporations represented, and they are
duly authorized to sign in a representative capacity.

The said instrument is a XX, consisting of xx (xx) pages including this page in which their
acknowledgment is written and signed by the Parties and their instrumental witnesses on each
and every page thereof.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2022.