Republic of the Philippines

Fourth Judicial Region

Regional Trial Court
Office of the Executive Judge
______________, ________

IN RE: PETITION FOR RENEWAL OF ) SPEC. PROC. CASE

NOTARIAL APPOINTMENT/COMMISSION ) NO. _____________
AS NOTARY PUBLIC, )
)
)
)
_______________________________, )
Petitioner. )
X ................................................................... XX

PETITION

Petitioner _____________________________, to this Honorable Court, most

respectfully states that:

1. Petitioner is of legal age, Filipino, (civil status) , and a resident of

____________________________________________-;

2. He is a member of the Philippine Bar having completed the required course in law
in _________________________________________, passed the Bar
Examinations in the year _____ and was admitted to practice law in the Philippines
in _____________ after obtaining his Roll of Attorney No. ________________;

3. He was previously appointed/commissioned as Notary Public in ____________ for

the years _______ to ___________ and has submitted all Notarial Reports and
other requirements as Notary Public as evidenced by the Certification/Transfer
Clearance dated ___________________ issued by the Office of the Clerk of
Court/Notarial Section of RTC - _________ City, _____________, attached
herewith as Annex “A” and made an integral part of this petition;

4. He desires to transfer his Notarial Commission and be appointed/commissioned

as Notary Public for and in the Municipalities/Cities of
________________________, all in the Province of ______________,
considering that the undersigned is now holding office at
_____________________________________;

5. For the purpose of securing his notarial re-appointment conformably to the 2004
Rules on Notarial Practice, he would like to state that he possesses all the
qualifications and none of the disqualifications for the said office as evidenced by
the following averments:
Petition for Appointment/Commission as Notary Public Page 2

a. Petitioner is a natural born citizen as well as resident of the Philippines for more
than one (1) year and is over twenty-one (21) years of age having been born
on _________________ at ______________________________________;

b. Petitioner is a resident of ____________________________ since March

_______________ and can be contacted through his residential Telephone
Number: ________________ and Mobile Phone No.
_____________________

c. Petitioner is and will be maintaining as well as holding notarial office at his law
office located in _________________________________, which is within the
jurisdiction of this Honorable Court where herein notarial commission is sought
for;

d. That petitioner has not been convicted of any crime involving moral turpitude
nor has any pending administrative case whatsoever and has been a member
of the Philippine Bar in good standing.

e. That petitioner has duly complied with the requirements regarding the payment
of IBP Membership Dues, PTR, and MCLE Compliance.

In support of the foregoing requisites, the following are hereto attached:

5.1 Certification of Good Standing dated _____________________ issued by

the Office of the Bar Confidant (Annex “B”);

5.2 Certification of Good Standing dated ____________________ issued by

the Integrated Bar of the Philippines (IBP) National Office (Annex C);

5.3 Certification of Good Standing issued by IBP ___________ Chapter and

duly signed by two (2) executive officers thereof (Annex D);

5.4 IBP Official Receipt No. ____________ dated _____________________

as proof of advance payment for Membership Dues for the year
_______________(Annex E);

5.5 MCLE Certificate of Compliance [MCLE Compliance No.

________________ issued on __________________ (Annex F);

5.6 Professional Tax Receipt [PTR] (Annex G);

5.7 Three (3) Specimens of his Official Signature and Initial (Annex H);

5.8 True Impressions of his Dry Seal (Annex I);

5.9 Three (3) Passport-Size Color Photographs with light background and
signatures at the lower portion of the same (Annex J);
 5.10 Sketch of Office Location (Annex K).

PRAYER

WHEREFORE, in view of the foregoing premises, petitioner respectfully prays

that he be appointed/commissioned as Notary Public for and in the Municipalities/Cities
of_____________________, all in the Province of ______________, and accordingly,
take his oath of office as such.

All other relief and remedies just and appropriate under the foregoing premises are
likewise, most respectfully implored.

_______________, for _____________, _____ December _________.

___________________________________
Petitioner
Address: ___________________________________
Roll of Attorney No. ____________
IBP No. ___________ ___/___/____ (for Year ________) _______
PTR No. _____________ ___/___/___ ____________, _____
MCLE Compliance No. ___________ ___/___/______

VERIFICATION AND CERTIFICATION

(Required under SC Admin. Circular No. 04-94
and Revised Circular No. 28-91)

I, __________________, of legal age, Filipino citizen, ___(civil status)___, a lawyer

by profession, and a resident of______________________, after having been duly sworn
to in accordance with law, hereby depose and state that:

1. I am the Petitioner in the above-captioned case;

2. I caused the preparation as well as the filing of the foregoing Petition;
3. All the factual allegations herein are true and correct according to my
personal knowledge and the authentic records in my possession;
4. I have not commenced any other action or proceeding involving the
same issues in the Supreme Court, the Court of Appeals or any other
tribunal or quasi-judicial agency;
5. To the best of my knowledge, there are no such action or proceeding
involving the same issues pending before the Supreme Court, the Court
of Appeals or any other tribunal or quasi-judicial agency; and

6. Should I hereafter learn that a similar action or proceeding has been filed
or is pending before the Supreme Court, the Court of Appeals, or any
other tribunal or quasi-judicial agency, I shall undertake to report such
fact within five (5) days therefrom to this Honorable Court.
Petition for Appointment/Commission as Notary Public Page 4

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of

_______________________ in the Municipality/City of ______________________,
_______________________, Philippines.

_______________________________
TIN: __________________

SUBSCRIBED AND SWORN to before me this _______ day of

___________________ in ________________________________, affiant personally
exhibiting to me his ___________________________ issued by _____________ on
____________________ and expiring on _________________, which serves as his
Competent Evidence of Identity pursuant to the 2004 Rules on Notarial Practice.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of _______.