REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

THIRD JUDICIAL REGION
__________ City, __________

IN RE: PETITION FOR

APPOINTMENT AS NOTARY
PUBLIC FOR AND IN THE
PROVINCE OF__________,
NOTARIAL CASE NO. _________

_________________________,
Petitioner
x--------------------------------------------x

PETITION

PETITIONER, respectfully alleges that:

1. He is of legal age, Filipino, and a resident of and with postal address

at ___________________________________ City;

2. He was born on __________________

at_____________,_______________;

3. His mobile phone number is 09______________;

4. He is a member of the Philippine Bar, having passed the bar

examination and admitted to the practice of law on _____________,
and that his roll number is _____________; copy of the certification
dated 15 July 2020 from the Office of the Bar Confidant, Supreme
Court , Manila, stating that he has no pending administrative case
against him before said office is hereto attached (Annex A);

5. He is a member of the Integrated Bar of the Philippines with IBP

membership No.____________1 January 2020;

6. He has paid his PRT for the year 2020 as evidenced by O.R. No. PTR
No._____________21 January 2020/Makati City;

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 7. Attached to this petition is a copy of the certification of good
standing (Annex B) and good moral character (Annex C) of the
undersigned petitioner ;

8. He has paid the filing fees of this petition;

9. Attached also to this petition are three (3) passport-size color

photographs with signatures of the Petitioner (Annex D);

10.He desires to be appointed as Notary Public for the years 2020-2021;

11.He has never been convicted of any crime involving moral turpitude
as proof of the attached NBI Clearance (Annex E);

12.Attached here also in a separate sheet of paper and forming part of

this Petition are the three (3) specimens of Petitioner’s official
signature (Annex F) and his NBI Clearance (Annex G).

WHEREFORE, it is most respectfully prayed to this Hon. Court that

Petitioner be appointed as Notary Public for the Province of ____________
for the periods January 3, 2020 to December 31, 2021.

___________________City, ______________ 09 October 2020

_________________________________
Petitioner

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 VERIFICATION

I, __________________________, of legal age, married, Filipino, with

residence at ___________________________ City, having been sworn in
accordance with law, do hereby depose and state that:
1. I have caused the preparation and filing of the petition in the above-
entitled case;

2. I have read the pleading and attest that the allegations in the
pleading are true and correct based on my personal knowledge, or
based on authentic documents;

3. The pleading is not filed to harass, cause unnecessary delay, or

needlessly increase the cost of litigation; and

4. The factual allegations therein have evidentiary support or, if

specifically, so identified, will likewise have evidentiary support after
a reasonable opportunity for discovery.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________________ at____________.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN to before me on ___in

______________, affiant exhibiting to me his _____________________.

Doc. No.___;
Page No.___;
Book No.___;
Series of 2020

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