Notarial Register - Blank form

Page No. JUDICIAL FORM 143, AS AMENDED PORMULARYONG PANGHUKUMAN BLG. 143 NOTARIAL REGISTER OF REHISTRO NOTARYAL NI Under appointment made on the Sa Nombramiento na ginawa noong ikaENTRY NUMBER

TITLE/DESCRIPTION PTION OF INSTRUMENT

NAMES & ADDRESSES OF PARTIES

NAMES & ADDRESSES OF WITNESSES

of ng Lungsod ng

ng

,

COMPETENT EVIDENCE OF IDENTITY

I HEREBY CERTIFY that during the past week

instruments were

pinatutunayan ko na noong nakaraang lingo

ang mga kasulatang

, Philippines, for the year , Pilipinas, para sa taong and expiring December 31, na magtatapos sa Disyembre 31,

DATE & TIME OF NOTARIZATION

TYPE OF NOTARIAL ACT*

executed ginawa sworn to pinanumpaan

FEES & O.R NO.

OTHER PLACE OF NOTARIZATION OTHER THAN OFFICE OF NOTARY PUBLIC AND/OR REMARKS

before me sa harapan ko

acknowledged tinanggap

DATE: Petsa

NOTARY PUBLIC Notaryo Publiko