COMES NOW herein petitioner and unto this Honorable Court most respectfully states:

      1. The herein petitioner is a Filipino citizen, of legal age, single/married and a resident of ________________________;

      2. That he is a member of the Philippine Bar, he having been admitted as such on _______________;

      3. That he has never been convicted of any crime or misdemeanor involving moral turpitude;

      4. That he is presently engaged in the general practice of law, with offices at ___________________;

      5. That he has fully paid the license for the practice of law for the year ______ under Official Receipt No. _________ dated __________at _______________, and has likewise fully paid his IBP membership for the year _____ under Official Receipt No. ________ on _________, copies of which are hereto attached as Annexes "A" and "B", respectively.

      WHEREFORE, the herein petitioner respectfully prays that he be appointed Notary Public in and for _______________ for the term ending December 31, ________.

      Naga City, ___________________.