Integrated Bar of the Philippines

Request for Issuance of Certificate of Good Standing

and Certificate of No Pending Case_v062020

IBP CERTIFICATION REQUEST FORM (Please write in capital letters)

IBP CHAPTER ROLL NUMBER LIFETIME MEMBER NUMBER

IBP Quezon City 69226

SURNAME FIRST NAME MIDDLE NAME

PASAMBA RONALD ANTHONY CARVAJAL

MAILING ADDRESS: EMAIL ADDRESS MOBILE NUMBER (enter 10-

2151 D1 CIRIACO TUAZON ST. MALATE, MANILA, 1004 digit number) e.g. 9151234567

ronaldpasamba@yahoo.com (917) 577-6994

PURPOSE OF CERTIFICATION:
FOR NOTARY PUBLIC APPLICATION

AUTHORIZATION FOR AUTHORIZATION FOR PICK-UP: PAYMENT DETAILS

DELIVERY BY COURIER:
I hereby authorize the Commission on
Bar Discipline and the IBP Accounting
Office to deliver the requested
Certification to my mailing address
indicated above via LBC or any other
courier.
I.D. OR. NO.
I hereby authorize the Commission on Bar
JEP-24-000829275
Discipline and the IBP National
Accounting Office to release copy/ies of
the requested Certification to:
ERWIN D. HIZON
________________________________________
(Name of Authorized Representative)
(please attach in the email the scanned copy
of ID of Authorized Representative upon
submission of this form)

RONALD ANTHONY C. PASAMBA RONALD ANTHONY C. PASAMBA

DATE:

Signature over printed name Signature over printed name 04/30/2024

Date: Date: ASSESSED BY:

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