FORM NO. 1.

Acknowledgment
(Simple Form)

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ________________ )
MUNICIPALITY OF _____________ ) S.S.1

BEFORE ME, this ____ day of ______________ , 2018 in the Municipality of

_________________, personally appeared:

Name Competent Evidence of Identity2 Place and Date of Issue

_____________ __________________________ ____________________

_____________ __________________________ ____________________

known to me to be the same person who executed the foregoing instrument, and
acknowledged that the same are their free act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial

seal on the date and place above written.

Doc No. ; NOTARY PUBLIC for ____________________

Page No. ; Commission Serial No. _________________
Book No. ; Until December 31, 2018
Series of . Roll of Attorney _____________________
IBP No. _____________ /Date/Place of Issue
PTR No. _____________ /Date/Place of Issue
MCLE No. ____________ /Date of Issue