REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

SIXTH JUDICIAL REGION
BACOLOD CITY
-oOo-

IN RE: PETITION FOR COMMISSION AS

NOTARY PUBLIC FOR THE CITIES OF
BACOLOD AND TALISAY AND THE
MUNICIPALITIES OF MURCIA AND DON
SALvADOR BENEDICTO, ALL IN THE
PROvINCE OF NEGROS OCCIDENTAL,

ATTY.,

Petitioner.

x--------------------------------------------------------------------x

PETITION

PETITIONER, unto this Honorable Court, most respectfully files this petition/application
for Commission as Notary Public for the Cities of Bacolod and Talisay and the Municipalities of
Murcia and Don Salvador Benedicto, all in the province of Negros Occidental, for the term
ending December 31, 2020. In support of this Petition, she states that:

1. She possesses the eligibilities for commissioning as Notary Public as shown by her
following personal circumstances:

Nationality: Filipino
Date/Place of Birth: Negros Occidental
Residence: Bacolod City
Contact Number:
PTR Number:
Roll of Attorney’s Number:
IBP Official Receipt Number:

2. She holds office at the following address:

3. Petitioner is a resident of the Philippines since birth;

 4. She has no pending administrative case before the Office of the Bar Confidant, Supreme
Court of the Philippines as supported by the Certification date ____ issued by MA.
CRISTINA B. LAYUSA, Deputy Clerk of Court and Bar Confidant of the Supreme Court of
the Philippines, hereto attached as Annex __. Additionally, no criminal case has been
filed against him as shown by the Clearance issued by the National Bureau of
Investigation (NBI), attached hereto as Annex

5. She has not been convicted, much less, charged with any offense involving moral
turpitude;

6. She is a member in good standing of the Philippine Bar as shown by the following
certifications:

Certification of No Pending Administrative Case filed against him issued by the Office of
Executive Judge, Regional Trial Court, Bacolod City (Annex __).

Certification as a Member in Good Standing issued by the IBP-Negros Occidental

Chapter (Annex ___).

IBP Official Receipt ______ for Payment of Membership Fee (Annex ____)

7. Three of her identification pictures with corresponding signatures at the bottom are
attached in this Petition as Annex _____.

8. She has not applied for nor was she issued a Commission as Notary Public in any other
jurisdiction for the current year;

9. Attached hereto is a separate sheet of paper which forms part of this Petition containing
three (3) specimens of Petitioner’s signature;

10. She now desires to be appointed and commissioned as Notary Public acting for and in
the Cities of Bacolod and Talisay and the Municipalities of Murcia and Don Salvador
Benedicto, all in the province of Negros Occidental, for the term ending December 31,
2020.

WHEREFORE, it is most respectfully prayed of this Honorable Court that the undersigned
Petitioner be appointed and commissioned as Notary Public for and in the Cities of Bacolod and
the Municipalities of Murcia and Don Salvador Benedicto, all in the Province of Negros
Occidental, for the term ending December 31, 2020, as well as for such other reliefs and
remedies just and equitable under the premises.

RESPECTFULLY SUBMITTED.

Bacolod City, Philippines, September 2, 2019.

 Petitioner
Roll No.
MCLE:
IBP OR No.
PTR OR No.
All issued in Bacolod City
Brgy. Estefania, Bacolod City

VERIFICATION/CERTIFICATION OF NON-FORUM SHOPPING

I, Kim L. Andaya, Filipino, of legal age, married and with office address at Estefania, Bacolod
City, Philippines, after being duly sworn to in accordance with law hereby state:

That I am the Petitioner in the above instant case;

That I have caused the preparation and the filing of the “PETITION FOR COMMISSION AS
NOTARY PUBLIC FOR THE CITIES OF BACOLOD AND TALISAY AND THE MUNICIPALITIES OF
MURCIA AND DON SALvADOR BENEDICTO, ALL IN THE PROvINCE OF NEGROS OCCIDENTAL”
dated September 2, 2019;

That I have read the same and that it is true and correct based on my personal
knowledge or based on authentic records;

That I hereby certify under oath in this petition, as follows:

I have not theretofore commenced any action or filed any action or claim involving the
same issue in any court, tribunal or quasi-judicial agency and, to the best of my knowledge, no
such other pending action or claim is pending therein;

If there is such other pending action or claim, a complete statement of the present
status thereof; and

If I should thereafter learn that the same or similar action or claim has been filed or is
pending, I shall report that fact within five (5) days therefrom to the court within the aforesaid
complaint or initiatory pleading has been filed.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ at Bacolod City,
Philippines.

Petitioner

SUBSCRIBED AND SWORN to before me this ____________ at Bacolod City, Philippines

with affiant exhibiting to me his TIN _______________ as competent proof of her identification.
Doc. No. ___
Page No. ___
Book No. ___
Series of 2019.