ORIGINAL

REPUBLIC OF THE PHILIPPINES

National Capital Judicial Region
Regional Trial Court
Quezon City

IN RE: PETITION FOR RENEWAL OF

APPOINTMENT AS NOTARY PUBLIC
FOR AND IN QUEZON CITY

NAME
Petitioner
x---------------------------------------------x

PETITION
The undersigned Petitioner, NAME, a resident of ADDRESS, with residence
landline number PHONE NUMBER, unto this Honorable Court most
respectfully states THAT:

1. Petitioner was previously issued a notarial commission effective on the

14th day of October 2016 and ending on the 31st day of December
2017. A copy of the Certificate of Notarial Commission, Oath of Office,
and the last transmittal of notarial report are attached herewith as
Annex “A” and “A-1,” and “A-2” respectively.

2. Petitioner is a Filipino Citizen, of legal age, born on May 22, 1988, with
office address at ADDRESS, and office address landline number of
(02)4163809.

3. She is a member of the Philippine bar, with Attorney’s Roll No. XXXXX,
as evidenced by a copy of the Certificate of Membership in the
Philippine Bar.1

4. She is a member of the Philippine Bar in good standing, as evidenced

by original copies of the following

a. Certification issued by the Office of the Bar Confidant;2

b. Certification issued by the Integrated Bar of the Philippines
Commission on Bar Discipline;3
c. Certification dated issued by the Integrated Bar of the Philippines
Quezon City Chapter.4

1
Annex “B” – Certificate of Membership in the Philippine Bar issued by the Office of the Bar Confidant
2
Annex “C”- Certificate of No Pending Administrative Case issued by the Office of the Bar Confidant
3
Annex “D” - Certificate of No Pending Administrative or Disbarment Case issued by the IBP Commission on Bar
Discipline
4
Annex “E” - Certificate of No Pending Administrative Case issued by the IBP Quezon City Chapter

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 5. She has attached hereto in a separate sheet of paper, but as part of
this Petition, three (3) specimens of her official signature, with
impression of her notarial seal.5

6. She has paid her professional tax for the current year, and a photocopy
of the receipt is attached as Annex “G”

7. Likewise, copy of her Community Tax Certificate and Taxpayer

Identification Number are likewise attached as Annex “H” and “H-1,”
respectively.

8. She has attached hereto in a separate sheet of paper, but as part of

this Petition, three (3) passport-sized color photographs with white
background and signature at the bottom taken within thirty (30) days
from date of application.6

9. She has paid her IBP Membership Dues for the year 2018 as
evidenced by the IBP Official Receipt7 and IBP Certification.8

10. She has never been charged nor convicted of any crime
involving moral turpitude as shown in the attached clearances issued
by the Quezon City Prosecutor’s Office,9 Metropolitan Trial Court,10
Regional Trial Court,11 and National Bureau of Investigation.12

11. Pictures of her office where she will be accomplishing her

notarial duties are likewise shown by the attached pictures.13

12. Petitioner dutifully complied with the Mandatory Continuing Legal

Education program, as shown by his certificate attached herein as
Annex “P.”

13. She undertakes to inform the Executive Judge within TEN (10)
days in case of any change in the given address and to submit the
monthly report religiously.

14. She has all the qualifications and none of the disqualifications for
the same office.

Wherefore, it is respectfully prayed of this Honorable Court, after due

notice, publication and hearing, that the petitioner’s Notarial Commission for
and in Quezon City be renewed.

5
Annex “F” – Notarial Seal and Specimen Signature
6
Annex “I” – ID Picture of Petitioner
7
Annex “J” – Official Receipt – Payment of Membership Dues in the Integrated Bar of the Philippines
8
Annex “J-1” – IBP Certification on payment of Membership Dues for the year 2018
9
Annex “K” – Quezon City Prosecutor’s Office Clearance
10
Annex “L” – MTC Clearance
11
Annex “M” – RTC Clearance
12
Annex “N” – NBI Clearance
13
Annex “O” – photographs of the office of the Petitioner where she will practice her notarial commission

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Quezon City, 16 July 2018

NAME
Roll of Attorneys No. XXXXX
IBP No. 026260 / 01-11-2018 / Pasig City
PTR No. 5609611 / 01-08-2018 / Quezon City
MCLE Compliance No. _______________
Email address: xxxxxxx
Mobile Number: 0917xxx
Phone Number: xxx

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 VERIFICATION AND CERTIFICATION
AGAINST FORUM SHOPPING

I, name, of legal age, married, and with office address at address, after
having been duly sworn in accordance with law, depose and state:

1.) That I am the Petitioner in the foregoing Petition.

2.) That I have caused the preparation of said Petition.

3.) That I have read the allegations therein contained, and that the same
are true and correct of my personal knowledge or based on authentic
records.

4.) That I have not therefore commenced any action or filed any claim
involving the same issues in any court, tribunal, or quasi-judicial agency
and, to the best of my knowledge, no such other action or claim is
pending therein; and if I should thereafter learn that the same or similar
action has been filed or is pending, I shall report that fact within five (5)
days therefrom to the court wherein the aforesaid initiatory pleading has
been filed.

WITNESS MY HAND AND SEAL this _____ day of _______________ 2018 at

____________________, Philippines.

name
Affiant

SUBSCRIBED AND SWORN to before me this _____ July 2018, at Quezon City,
affiant exhibiting to me her ID: Integrated Bar of the Philippines (Roll No.) XXXX
as her competent evidence of identity. I hereby certify that I have personally
examined the affiant and that I am satisfied that she fully understood the contents
of the foregoing and voluntarily executed the same.

Doc. No. __________

Page No. __________
Book No. __________
Series of 2018

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