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Republic of the Philippines

REGIONAL TRIAL COURT


8th Judicial Region
Branch 24
Bulwagan ng Katarungan
Maasin City, Southern Leyte

IN THE PETITION FOR COMMISION


AS NOTARY PUBLIC IN AND FOR THE
PROVINCE OF SOUTHERN LEYTE
DAEL CHURCHILL T. GERONG,
Petitioner.
x-------------------------------------------------------x

PETITION
COMES NOW, the Petitioner and unto this Honorable Court, most respectfully states
that:
1. Petitioner is of legal age, having been born on March 9, 1988, married, Filipino citizen
and presently residing at Brgy. Mantahan, Maasin City, Southern Leyte;
2. Petitioner has been admitted to the practice of law in the Philippines as shown by the
Certificate of Membership in the Philippine Bar, which contains the Petitioners Roll of
Attorney No. 65389. A copy of the Certificate of Membership in the Philippine Bar is
attached and marked as Annex A hereof;
3. Petitioner is likewise a bona fide member in good standing of the Integrated Bar of the
Philippines as shown by his Certificate of Good Moral Character. A photocopy of his IBP
Receipt showing his IBP No. 1036160 is attached and marked as Annex B hereof. Also
attached and mark herewith as Annex C is the Certificate of petitioners good moral
character issued by Atty. Renato Ramon B. Rances, III and Atty. Aemilda B. Madredijo,
President and Secretary, respectively, of the IBP Southern Leyte Chapter;
4. Petitioner has also paid the Professional Tax Receipt due him as evidenced by PTR No.
0286272, dated 06/23/2016, a photocopy of which is also attached herewith as Annex
D;
5. Petitioner has all the qualifications and none of the disqualifications for the Office of the
Notary Public;
6.

Petitioner has never been charged nor convicted of any crime involving moral turpitude;

7. Petitioner has no commission as notary public in any other jurisdiction;


8. Petitioner has attached hereto in a separate sheet of paper specimen of his official
signatures and marked as Annex E and made an integral part hereof; and

Petition for Notarial Commission


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9. Petitioner has likewise attached thereto his three (3) passport size photographs each
bearing his signature on the bottom part thereof as Annex F hereof.
PRAYER
WHEREFORE, Petitioner respectfully prays of this Honorable Court that his petition
for Notarial Commission be granted.

Respectfully submitted.

Maasin City, Southern Leyte, Philippines.

DAEL CHURCHILL T. GERONG


Tomas Oppus St., Mantahan,
Maasin City, Southern Leyte
Roll of Attorneys No. 65389
IBP No. 1036160, Southern Leyte, June 15, 2016
PTR No. 0286272, June 23, 2016
MCLE Compliance: Exempted, pursuant to
MCLE Governing Board Order No. 1, s.2008

Petition for Notarial Commission


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Republic of the Philippines )


Province of Southern Leyte ) S.S
City of Maasin
)
x------------------------------------------------x

VERIFICATION
I, DAEL CHURCHILL T. GERONG, Filipino, of legal age, married and a resident of
Brgy. Mantahan, Maasin City, Southern Leyte, after having duly sworn to in accordance with
law, do hereby depose and say that:
1. I am the petitioner in the above-entitled Petition;
2. I have caused the preparation of the foregoing Petition; and
3. I certify that I have read and understood the contents thereof and verify that the facts
stated therein are true and correct based on my personal knowledge and authentic
records.
IN WITNSESS WHEREOF, I have hereunto affixed my signature this ______ day of
______, 2016, at ______________.

DAEL CHURCHILL T. GERONG

SUBSCRIBED AND SWORN TO BEFORE ME in the City of Maasin this______ day


of ______________, 2016 by DAEL CHURCHILL T. GERONG, a person known to me and to
me known to be the same person who personally signed before me the foregoing Petition and
acknowledged that he executed the same, and exhibiting to me his Drivers License as competent
proof of his identity.

Doc. No. ______;


Page No. ______;
Book No. ______;
Series of 2016.

__________________________
Notary Public

Petition for Notarial Commission


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ANNEX A
CERTIFICATE OF MEMBERSHIP IN THE PHILIPPINE BAR (PHOTOCOPY)

Petition for Notarial Commission


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ANNEX B
CERTIFICATE OF GOOD STANDING FROM OBC

Petition for Notarial Commission


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ANNEX C
PHOTOCOPY OF IBP RECEIPT

Petition for Notarial Commission


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ANNEX D
CERTIFICATE OF GOOD MORAL CHARACTER
FROM IBP _________ CHAPTER

INTEGRATED BAR OF THE PHILIPPINES


______Chapter
________ City

CERTIFICATION
THIS IS TO CERTIFY that ATTY. _______ of _________ is a Member of the Integrated
Bar of the Philippines per her IBP No. ______ and is a bona fide member of the Integrated Bar
of the Philippines, ______Chapter, Philippines.
This certification is issued upon the request of ___________ for all legal intents and
purposes.
___________, Philippines, ___________.

ATTY._______________________
Chapter Secretary

ATTY._______________________
Chapter President

Petition for Notarial Commission


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ANNEX E
PHOTOCOPY OF PTR RECEIPT

Petition for Notarial Commission


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ANNEX F

SPECIMEN SIGNATURES OF ATTY.

1. __________________________________

2. __________________________________

Petition for Notarial Commission


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ANNEX G
PHOTOGRAPH WITH SIGNATURE

Petition for Notarial Commission


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ANNEX H

Republic of the Philippines


REGIONAL TRIAL COURT
_______ Judicial Region
OFFICE OF THE EXECUTIVE JUDGE
______ City

APPOINTMENT

BE IT KNOWN THAT:
ATTY. ________ is a resident of ________ss City, Philippines, is appointed by
me as NOTARY PUBLIC for and within the Province of ________, Philippines, for a term
starting from the ____________________ day of __________ to _____________of
____________ Anno Domini, Two Thousand Thirteen (2013).

GIVEN UNDER MY HAND and caused the Seal of this Court to be affixed
thereon, this____ day of ___, Anno Domini, Two Thousand Thirteen (2013) at the City of
_______, Philippines.

Executive Judge

Petition for Notarial Commission


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ANNEX I
TRUE IMPRESSION OF THE NOTARIAL DRY SEAL OF ATTY.