FORM NO.

4 ACKNOWLEDGMENT BY CORPORATION

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ______________)
MUNICIPALITY OF __________) S.S.

BEFORE ME, this _______ day of ______________, 19____ in the Municipality of

__________________, Province of __________________, Philippines, personally appeared
________________________________, representing to be the President (or Manager) of
_________________________, known to me to be the same person who executed the
foregoing instrument for and in behalf of the said corporation, and he acknowledged to me that
the same is the corporate act and deed of _____________________, and that he is duly
authorized to sign the same. The said ____________________ exhibited to me his Residence
Certificates A No. ______________ and B No. ______________ issued at ________________,
________________, on ________________, ________________, with Tax Account Number
_______________________.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal, the
day, year, and place above written.

NOTARY PUBLIC
My commission expires Dec. 31, 19____

Not. Reg. No. _______________;

Page ________; Book ________;
Series of 19____.