(Acknowledgement by an Individual – One-Party Instrument)

REPUBLIC OF THE PHILIPPINES)

City/Municipality of_____________) S.S.

ACKNOWLEDGEMENT

            BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _______________, personally appeared ______________ with Community Tax Certificate No. _______________ issued on _______________ at _____________ (and Tax Identification NO. (T.I.N.) ______________), known to me and to me known to be the same person who executed the foregoing instrument which (he/she) acknowledged to me as (his/her) free and voluntary act and deed, consisting of only ________ (_____) page/s, including this page in which this Acknowledgement is written, duly signed by (him/her) and (his/her) instrumental witnesses on each and every page hereof.

            WITNESS MY HAND AND SEAL this ______________at _______________, Philippines

                                                                                    NOTARY PUBLIC

Doc. No.________;

Page No.________;

Book No.________;

Series No________;

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