(Acknowledgment by Individuals - Multi-Party Instrument)

REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF ______) SS.
x-----------------------------------------x
ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of
_____________, personally appeared the following persons, with their respective Community
Tax Certificates as follows:
Name
1. _____________
2. _____________
3. _____________

C.T.C. No.

Date / Place Issued

_____________
_____________
_____________

_____________
_____________
_____________

all personally known to me (or whom I have identified through competent evidence of identity)
and who represented to me that their respective signatures on the foregoing instrument were
voluntarily affixed by them for the purposes stated in the instrument and who declared that they
have executed the foregoing instrument as their free and voluntary act and deed.
This Instrument consists of only ______ (____) page/s, including this page in which this
acknowledgment is written, duly signed by the parties and his instrumental witnesses on each
and every page hereof.
WITNESS MY HAND AND SEAL this _____________ at _____________,
Philippines.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 20____.