Republic of the Philippines

REGIONAL TRIAL COURT

First Judicial Region
Justice Hall, Baguio City

OFFICE OF THE EXECUTIVE JUDGE

IN RE: PETITION FOR N. A. No.________

APPOINTMENT AS NOTARY
PUBLIC FOR AND IN THE
CITY OF BAGUIO

________________________
Petitioner.

PETITION
For Notarial Commission

Petitioner most respectfully manifests:

1. She is a Filipino citizen, 35 years of age, born on _____________
at __________________, married, and a resident of No.
___________________________;

2. She has satisfactorily completed the required course in law at

University of __________ on _______________.

3. After having successfully passed the 20____ Bar Examinations,

she was admitted to the Philippine Bar on _____________ and was
assigned with Roll of Attorneys No. ______________. A machine
copy of her Certificate of Membership in the Philippine Bar issued
by the Office of the Bar Confidant, Supreme Court of the
Philippines, is marked and attached as Annex “A” and made an
integral part this petition;

4. She holds and maintains office at the _____________________

_________________________ with telephone numbers
____________________________________;

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5. She is a bona fide member of good standing of the Integrated Bar
of the Philippines, __________________ Chapter having paid her
annual membership dues for the calendar year ________ as
evidenced by IBP Receipt No. ________________ dated
________________. A copy of the receipt is attached as Annex
“B”;

6. She has also been issued by the Office of the Treasurer of

________ City on _____________________ a Professional Tax
Receipt (PTR) numbered _______________ for the calendar year
__________. A photocopy of the PTR receipt is attached as Annex
“C” and made to form part of this petition;

7. She is a member of good standing, without any administrative

penalties imposed upon him and has never been convicted of any
crime involving moral turpitude as shown by the Certification issued
by two (2) executive officers of the IBP ________________
Chapter which is attached as Annex “D” and made to form part of
this petition;

8. She has no criminal record with the National Bureau of

Investigation as evidenced by the NBI Clearance herewith attached
as ANNEX “E”;

9. She has no pending administrative case against her before the

Supreme Court as evidenced by the certification dated
_____________________, issued by the Office of the Bar
Confidant, Supreme Court, Manila, the Certification is herewith
attached as ANNEX “F”;

10. She has no pending criminal case filed against her before the
Regional Trial Court, _________________, as evidenced by RTC
Clearance dated ________________-- issued by the Office of the
Clerk of Court of the Regional Trial Court of _______________, the
RTC Clearance is attached as ANNEX “G”;

11. She desires to apply for her Notarial Commission as she

possesses all the qualifications and none of the disqualifications for
said office;

12. She most respectfully submits three (3) of her latest passport-
sized identification photographs, and three (3) specimen
signatures below the said ID pictures, and attached as ANNEX “H”.

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 PRAYER

Therefore, the Petitioner most respectfully prays that upon

compliance with the guidelines provided under the 2004 Rules on
Notarial Practice and related laws, Petitioner’s appointment as a
Notary Public for and in the __________________ be GRANTED.

Respectfully submitted this ____ day of January, in the Year of

our Lord, Two Thousand and _______________________, in the
_______________.

Atty. _______________________
Petitioner
IBP No.
PTR No.
MCLE No.

VERIFICATION AND CERTIFICATION AGAINST FORUM

SHOPPING

I, CAROLINA G. LIM-GAMBAN, under oath, depose and state that:

1. I am the petitioner in the above-entitled petition;

2. I have caused the preparation of the foregoing Petition;

3. The allegations above are true and correct based on my

personal knowledge and authentic records;

4. To the best of my knowledge, there are no other pending

petitions of the same nature before any court, tribunal or quasi-
judicial agency; and

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 5. Should I thereafter learn of any similar case pending before any
other court, tribunal or quasi-judicial agency, I shall promptly
notify this court within five (5) days from discovery.

________________________________
Petitioner

SUBSCRIBED AND SWORN to before me in ___________ on this

______________________, affiant exhibiting before me her IBP ID
issued on __________ in _________________.

_____________________________
Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.

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