REPUBLIC OF THE PHILIPPINES )

PROVINCE OF )
MUNICIPALITY/CITY OF ) S. S

BEFORE ME, this _____ day of _______ 2022 in the Municipality/City of ________,
Province of ____________, Philippines, personally appeared ______________ with (type of ID
and ID number) issued at _________on __________, known to me to be the same person who
executed the foregoing instrument and he/she acknowledge to me the same is his/her free act and
deed.

This instrument, consisting of _____ pages, including the page on which this
acknowledgement is written, has been signed on the left margin of each and every page thereof
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.

Doc No.
Page No.
Book No.
Series of 2022