(ACKNOWLEDGMENT) LEGAL FORMS

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA )

BEFORE ME, this 16th day of June, 2022, in the City of Manila, personally appeared Mr. X with LTO
LICENSE NO. 12344, ISSUED ON: May 25, 2019 in LTO City of Manila and with EXPIRATE DATE ON:
December 5, 2022, known me to be the same person who executed the foregoing instrument and acknowledged that
the same is his free act and deed.

This instrument, consisting of three (3) pages, including the page on which this acknowledgment written,
has been signed by the above – named person and his instrumental witness on each and every page thereof.

IN WITNESS WHEREOF, I set unto my hand and seal on the date and place above written.

(Sgd.) ATTY. JUAN DELA CRUZ

Notary Public for Manila
Appointment No. 123
Until December 31, 2022
Roll No. 123456; 5/20/05
IBP No. 13456/ January 1, 2019/ City of Manila
PTR No. 213456/ January 1, 2022/ City of Manila
MCLE NO. I – 0001223; 9/09/2021
MCLE NO. II – 0002345; 9/09/2022

DOC. NO. 34
PAGE NO. 23
BOOK NO. III
SERIES OF 2022

By: Caffeinated Wisdom

Page 1