NOTARIAL REGISTER OF ATTY. GENEVIEVE S.

TERSOL

Under appointment made on the ____________ of _____________________________________,

NAMES &
ENTRY TITLE/DESCRIPTION NAMES & ADDRESSES
ADDRESSES OF
NUMBER OF INSTRUMENT OF PARTIES
WITNESSES
Page ____

Judicial Form No. 143, as amended

of _____________________________________, Philippines, for the year

and expiring December 31

OTHER PLACE OF
COMPETENT NOTARIZATION
DATE & TIME
EVIDENCE TYPE OF FEES & OTHER THAN
OF
OF NOTARIAL ACT O.R. NO. OFFICE OF
NOTARIZATION
IDENTITY NOTARY PUBLIC
AND/OR REMARKS
 executed
I HEREBY CERTIFY that during the past week instruments were sworn to
before me.
Acknowledged

Date _____________________________________ ATTY. JAYDEE

PEREGRINO-CO
Notary Public