ACKNOWLEDGMENT

Republic of the Philippines}

City of Cebu} S.S.

BEFORE ME, a Notary Public for and in the City of Cebu, this ___ day of __________ personally appeared
______________________ who is known to me through competent form of identification consisting of _____________
expiring on ___________ and to me known to be the same person who executed the foregoing instrument and he
acknowledged to me that he voluntarily affixed his signature therein and that the same is his free and voluntary act and
deed.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.

JURAT

SUBSCRIBED AND SWORN TO before me, a Notary Public for and in the City of Cebu, this ___ day of
__________ 2014 at the City of Cebu, Philippines. Affiant is personally known to the notary through competent form of
identification consisting of _______________ expiring on ______________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.

CERTIFICATION

I hereby certify that a ____________ was presented to me that is neither a vital record, a public record, nor
publicly recordable, the copying of which was supervised by me and that I have compared the said copy with the original
copy finding it to be accurate and complete.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.

AFFIRMATION/OATH

BEFORE ME, Notary Public for and in the City of Cebu, this ___ day of __________, 2014, personally appeared
______________________ who is known to me through competent form of identity consisting of _____________ expiring
on ___________ and to me avowed under the penalty of law to the whole truth of the contents of this instrument.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.

SIGNATURE WITNESSING

BEFORE ME, a Notary Public for and in the City of Cebu, this ___ day of __________, 2014, personally appeared
______________________ who is known to me through competent form of identity consisting of _____________ expiring
on ___________ and to me known to be the same person who affixed his signature in my presence and that the same is
his free and voluntary act and deed

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.