Office of the Executive Judge

____________ City, Philippines

__________(DATE)

LETTER REQUEST
For CERTIFICATE OF AUTHORITY FOR A NOTARIAL ACT

__________________
Executive Judge
Regional Trial Court
__________________

Honorable Judge:

Good day!

As a Notary Public for the City of _________, with Notarial Commission No.
_______ valid until __________, ______________________ had notarized the
following document:

Title of Document : ____________________

Date of Notarization : ____________________
Doc. No : ____________________
Page No. : ____________________
Book No. : ____________________
Series of Year : ____________________

I respectfully request for your good Office’s Certification that said Notarial Act is
valid and binding in this Jurisdiction and valid for such legal purpose so stated.

Respectfully,

__________________________