REPUBLICOFTHEPHILIPPINES

REGIONALTRIALCOURT
7THJUDICIALREGION
Branch____
___________City

PETITION FOR APPOINTMENT AS

INRE: NOTARY PUBLIC FOR THE CITY

OF
_____________
AND
THEMUNICIPALITIES UNDER THE
JURISDICTION
OF
THIS
HONORABLE COURT

CASE
NO:________

________________________________
(NameofApplicant)

Petitioner
x/

PETITION
PETITIONER, _________________, unto this Honorable Court, most
respectfullyalleges:
1.

Petitionerisof___yearsold,forhavingbeenbornon____________.
He/She is a Filipino Citizen, married, has been a resident of
_______________,Philippinessincehis/herbirth.She/Heiswiththe
office address and regular place of business at
_________________Philippines with telephone numbers: (032)
_________________ and 09_________________ ; and in which
jurisdictionhe/shenowappliestobegivenaNotarialCommission.In
theevent,however,thatthePetitionerceasestomaintaintheaforesaid
place of business, he/she hereby undertakes to notify this Honorable
Courtwithinten(10)daysfromsuchchangeofbusinessaddress;

2.

He/She has never beencharged or convicted of any crime involving

moralturpitude,andherewithattachedisaclearancefromtheRegional
Trial Court __________ City, as ANNEX A of this Petition; and
ClearanceissuedbytheNationalBureauofInvestigation(NBI)dated
__________hereinattachedasANNEXA1

3.

He/SheisamemberofthePhilippineBarwithRollNumber________,
asevidencedbyCertificateofMembershipinthePhilippineBardated

__________,acopyofwhichisheretoattachedas ANNEXB and

madeandintegralpartofhereof;
4.

He/Shehaspaidhis/herprivilegetaxesfortheyear2016asevidenced
byProfessionalTaxReceiptNo._____,dated__________,acopyof
whichisattachedheretoandmadeanintegralparthereofas ANNEX
C;

5.

He/She is a member of good standing of the Integrated Bar of the

Philippines,beingamemberthereof,asevidencedbyaClearancefrom
theIntegratedBarofthePhilippinesCebuChapterandforwhomtwo
(2) executive officers of the Integrated Bar of the Philippines Cebu
ChapterissuedaJointCertificationofhis/herbeingamemberofgood
standingandofhis/hergoodmoralcharacter,whichJointCertification
isattachedas ANNEXD herewith;likewise,aClearancefromthe
OfficeoftheBarConfidant,dated___________isattachedherewithas
ANNEXE;

6.

He/ShehaspaidtherequiredIBPMembershipDuesforCY2016,and
BuildingFundcontributiontotheIntegratedBarofthePhilippinesas
evidencedbyOfficialReceiptNo.___________,dated_____________,
acopyofwhichisattachedheretoandmadeanintegralparthereofas
ANNEXF;

7.

Three(3)unretouchedpassportsizecoloredphotographsofPetitioner,
taken within thirty (30) days before the filing of this Petition, with
his/hersignatureatthebottomthereonisattachedherewithasANNEX
G;

8.

Facsimilesofpetitionerssignatureappearonthesheetofpaperattached
heretoandmadeanintegralparthereofasANNEXH;

9.

Thatproperandadequatepaymentismadeforthefilingofthispetition
asrequiredbytherules.OfficialReceiptasproofofpaymentisincluded
inthispetitionas:

RTCO.R.No.__________,dated___________,=P=________;
RTCO.R.No.__________,dated___________,=P=________;

RTCO.R.No.__________,dated___________,=P=________;
10.

Petitioner has not applied for commission in any other court of the
Philippines.

PRAYER
WHEREFORE,itisherebyrespectfullyprayedthatPetitionerbegrantedan
appointment as Notary Public for and in the City of _____________ and in the
Municipalitiesof_____________PhilippineswithinthejurisdictionofthisHonorable
Court,foryear2016untilDecember31,2017.
Also Petitioner prays that he/she be issued a certificate of authorization to
purchaseaNotarialSeal.
Respectfullysubmitted.
Donethis_____________in_____________Cebu,Philippines.

Atty._________________
Address
RollNo._______
PTRNo.___________________
IBPNo.___________________
ExemptPursuanttoMCLEGoverningBoardNo.1
Seriesof2008
AdmittedJune________2016
Contact#________________/Email______________

RepublicofthePhilippines)
Cityof________________)S.s
VERIFICATIONANDCERTIFICATIONOFNONFORUMSHOPPING

I,___________________,legalage,Filipino,single/married,andaresidentof
______________afterhavingbeensworntoanoathinaccordancewiththelaw,depose
andsay;
ThatIamthePetitionerintheaboveentitledproceedingsthatpreparedtheforegoing
petition;
ThatIhavereviewedthePetitionandtheallegationsthereinaretrueandcorrectbased
onmypersonalknowledgeorbasedonauthenticrecords.
Further, I certify that I have not filed any other petition for issuance of notarial
commissioninanyothercourtortribunalinthePhilippines.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
________________in______________,Philippines.
_______________
Affiant

SUBSCRIBED AND SWORN to before me this ______________ in the City of

____________,Philippines,affiantexhibitedtomehis/hercompetentproofofidentity
indicatedas:_____________________.

Doc.___
Page___
Book___
Seriesof2016.