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ACKNOWLEDGMENT (Simple Form)

REPUBLIC OF THE PHILIPPINES )


ABUYOG, LEYTE ) S.S

BEFORE ME, this ___ day of ________, 2019 in Abuyog, Leyte,


personally appeared:

Name Competent Evidence of Identity Place and Date of Issue


____________ ______________________________ ______________________
____________ ______________________________ ______________________

known to me to be the same person who executed the foregoing


instrument, and acknowledged that the same is their free act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed


my notarial seal on the date and place above written.

NOTARY PUBLIC

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of ________.

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