REPUBLIC OF THE PHILIPPINES

11th Judicial Region

REGIONAL TRIAL COURT
Branch ___
Digos City
RE: PETITION FOR COMMISSION AS
NOTARY PUBLIC FOR AND IN THE
PROVINCE OF DAVAO DELSUR
ATTY. ROXANNE ZAPATOS JURIAL
Petitioner,
X----------------------------------------------/
PETITION FOR NOTARIAL COMMISSION
COMES NOW petitioner, unto this Honorable Court, most respectfully
avers:
1. That petitioner is of legal age, Filipino, single, resident of Aurora 3rd,
Digos City, and maintains a regular place of work at Jose Abad Santos
St., Digos City;
2. That she is a member in good standing of the Philippine Bar,
Integrated Bar of the Philippines and the Local IBP Chapter where she
belongs;
3. That she possesses all the qualifications and none of the
disqualifications for the Office of a Notary Public;
4. That she was never convicted of any crime involving moral turpitude;
5. That the following are the pertinent data in connection with this
petition;
Date of Birth
Residence
Telephone
Number
Professional Tax
Receipt No.
Issued on
Roll Number
IBP Membership
Number

:
:

July 18, 1990

Aurora 3rd St., Digos City

(082) 553 - 1234

:
:
:

1234567
January 5, 2016
12345

123456

6. That she is a person of good moral character as certified by two (2)

executive officers of the IBP, Local Chapter, copies of which are hereto
attached to form part of this petition;
7. That attached hereto are clearances from the Office of the Bar
Confidant of the Supreme Court and the Integrated bar of the Philippines
to form part of this petition;
8. That attached hereto is the receipt of the payment of the application
fee as proof of payment for the filing of this petition to form part of this
petition; and
9. That attached hereto, in a separate sheet of paper but a part of this
petition, are three (3) specimens of petitioners official signature, true
impression of her dry seal and three (3) passport size colored
photographs.
P R A Y E R
WHEREFORE, premises considered, it is most respectfully prayed of
this Honorable Court that petitioner be issued a commission as Notary
Public for and in the Province of Davao del Sur for the period starting
January 1, 2017 to December 31, 2018.
Petitioner prays for other reliefs just and equitable under the premises.
Digos City, Philippines, December 19, 2016

ROXANNE ZAPATOS JURIAL

Petitioner

REPUBLIC OF THE PHILIPPINES

PROVINCE OF DAVAO DEL SUR:S.S
CITY OF DIGOS CITY
)
X-------------------------------------------/
VERIFICATION AND CERTIFICATION
That I, ROXANNE ZAPATOS-JURIAL of legal age ,Filipino ,single and
a resident of Aurora 3rd St., Digos City, after having been duly sworn to in
accordance with law, do hereby depose and say;
That I am the Petitioner of the above-entitled case;
That I caused the preparation and filing of the same;
That I read and understood all the contents therein;
That they are all true and correct to the best of my knowledge and
belief;
That I have not commenced any other action or proceeding involving
the same issued in the Supreme Court, the Court of Appeals or any
tribunal or agency;
That to the best of my knowledge , no such action or proceeding is
pending in the Supreme Court, the Court of Appeals or any tribunal
or agency;
That is I should thereafter learn that a similar action or proceeding
has been filed or is pending in the Supreme Court , the Court of
Appeals or any tribunal or agency, I undertake to report the fact
within five (5) days therefrom to the Court or agency wherein the
original pleading and sworn certification herein have been filed.
IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of
December 2016 at Digos City, Philippines.

ROXANNE ZAPATOS JURIAL

Affiant

SUBSCRIBED AND SWORN TO before me this 19 th day of December

2016 at Digos City, Philippines.
Doc. No.
Page No.
Book No.
Series of:

JOHN LLOYD CRUZ

Notary Public
Until December 31, 2017
TIN No. 098-765-543
IBP No. 098765
PTR No. 432109
MCLE Compliance No. 000009

INTEGRATED BAR OF THE PHILIPPINES

DAVAO DEL SUR CHAPTER
Digos City, Davao del Sur
Philippines
CLEARANCE &
CERTIFICATE OF GOOD MORAL CHARACTER
THIS IS TO CERTIFY that ATTY. ROXANNE ZAPATOS JURIAL
is a private practitioner for and in the Province of Davao del Sur.
This serves to certify that the above named lawyer is a member of the
Integrated Bar of the Philippines, Davao del Sur Chapter, she is a member in
good standing and has paid her IBP memberships due for the year 2016
under the Official Receipt No.123 dated December 1, 2016.
This clearance and certificate of good moral character is issued for
whatever legal purposes this may serve her best.
Done on this 19th day of December at Digos City, Davao del Sur,
Philippines.

ATTY. JUAN DELA CRUZ

Treasurer

ATTY. GABRIELA SILANG

Secretary

REPUBLIC OF THE PHILIPPINES

PROVINCE OF DAVAO DEL SUR:S.S
CITY OF DIGOS CITY
)
X-------------------------------------------/
AFFIDAVIT
That I, ROXANNE ZAPATOS JURIAL, of legal age, Filipino, single and
a resident of Aurora 3rd St., Digos City, after having been duly sworn to in
accordance with law, do hereby depose and say;
1. That I am the same ROXANNE ZAPATOS JURIAL who caused this
execution of this affidavit;
2. That I am a Practicing Lawyer by profession with office address as Jose
Abad Santos St., Digos City;
3. That as of date,I am applying for my notarial commission for and in the
Province of Davao del Sur and is filing a petition thereof with the Regional
Trial Court, Branch____, Digos City;
4. That as a requisite to the above-stated petition, I am manifesting herein
that I have never been convicted of any crime involving moral turpitude;
5. That this affidavit was executed to attest to the truth of the foregoing facts
and to support my petition for the renewal of my commission for and in the
Province of Davao del Sur.
IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of
December 2016 at Digos City, Philippines.

ROXANNE ZAPATOS JURIAL

Affiant
SUBSCRIBED AND SWORN TO before me this 19 th day of December
2016 at Digos City, Philippines.
Doc. No.
Page No.
Book No.
Series of:

JOHN LLOYD CRUZ

Notary Public
Until December 31, 2017
TIN No. 098-765-543
IBP No. 098765
PTR No. 432109
MCLE Compliance No. 000009

_________________________________

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