FORM NO.

1 ACKNOWLEDGMENT
(Simple Form)

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
________________________________, with Residence Certificates A No. ______________
and B No. ______________ issued at ________________, ________________, on
________________, ________________ 19___, respectively, and B.I.R. Tax Account No.
________________, known to me to be the same person who executed the foregoing
instrument, and he acknowledged to me that the same is his free act and deed.

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____.