FORM NO.

3 ACKNOWLEDGMENT OF INSTRUMENT CONVEYING TWO OR MORE

PARCELS OF LAND

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.

This Instrument relates to the sale (or mortgage) of ___________________ parcels of

land, and consists of ____ pages including the page on which this acknowledgment is written,
each and every page of which, on the left margin, having been signed by
________________________ and his witnesses, and sealed with my notarial seal.

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

NOTARY PUBLIC
My commission expires Dec. 31, 19____

Not. Reg. No. _______________;

Page ________; Book ________;