Protest of Bill of Exchange

BE IT KNOWN that on the ______day of ______________,20____ at

_____________A.M. in the city or municipality of _________________Philippines, at the
request of _____________ the holder of the draft hereinafter we forth, I _______________, a
duly commissioned Notary Public for and to ________________, personally presented the
original of said draft at ________________ to the drawer, and demanded payment (or
acceptance, as the case may be) thereof, which be refused saying ___________________,

That said draft is in words and figures following:

_____(Copy of draft)_____

WHEREUPON I, the said Notary, at the request aforesaid, did protest and by these
presents, do publicly protest as well against the drawer and indorsers of said draft, as against all
others whom it both or may concern, for exchange, re-exchange, and all costs, charges, damages
and interests already incurred or to be incurred by reason hereof.

AND I DO HEREBY CERTIFY that on the _____________________day of

_______________ , 20____notice of this protest, signed by me, was served upon _________
drawer (or indorser as the case may be), delivering the same to him personally in this (city or
municipality) (or by registered mail) at No.__________, such being his registered place of
residence.

THIS DONE and protested at____________ this _______day of

_______________,20___

NOTARY PUBLIC
My commission expires Dec. 31, 20__
Not.Reg.No._______

Page____________, Book______

Series of 20_____