Republic of the Philippines

REGIONAL TRIAL COURT

______Judicial Region
City of __________

OFFICE OF THE EXECUTIVE JUDGE

IN RE: IN RE: PETITION FOR NP__________

REAPPOINTMENT
AND RECOMMISSION AS NOTARY
PUBLIC FOR AND IN THE PROVINCE
OFAAMBUKLAO UNDER THE
TERRITORIAL JURISDICTION OF
THIS COURT

AAAA,
PETITIONER.
X------------------------------------X

PETITION

Undersigned Petitioner and unto this Honorable Court most respectfully files this
petition/application for reappointment and recommission as a Notary Public for
the municipalities/cities in the Province of ______________for a term ending on
December 31, _________. In support of this petition, she most respectfully states
that:

1. She was previously granted a Notarial Commission by Order dated DATE

signed by Executive Judge ____________. Attached is a copy of the
Order marked as Annex “A”.

2. She possesses the eligibility for commissioning as Notary Public as shown

by her following personal circumstances:

a. Nationality : Filipino
b. Date/ Place of Birth :
c. Residence :
d. Telephone No. :
e. PTR Number :
f. Roll of Attorney No. :
g. MCLE Compliance :
h. IBP Number :

3. Petitioner is a lawyer of good standing with clearances from the Office of

the Bar Confidant of the Supreme Court and the Integrated Bar of the
Philippines Albay Chapter, attached as Annexes “B” and “C” respectively;

1 |3
 4. Petitioner has not been tried nor convicted in the first instance of any crime
involving moral turpitude, nor charged in any administrative case in
connection with her present profession. Attached is a copy of NBI
clearance and marked as Annex “D”;

5. Petitioner is a registered member of the Integrated Bar of the Philippines

as supported by a photocopy of the Official Receipt of annual membership
dues for years 2020 and 2021, attached as Annex “E”;

6. She has paid her Professional Tax for the current year and was issued
Professional Tax Receipt (PTR) No._______________- dated
__________, copy of which is attached as Annex “F”;

7. She is a government employee and was given authority to practice her

profession by the Head of her office, copy of such written authority is
hereto attached as Annex “G”;

8. She has submitted her complete notarial records for the term of the
previous notarial commission in the Office of the Clerk of Court, Regional
Trial Court, ______________. Attached and marked is a copy of RTC
Clearance as Annex “H”; and

9. She undertakes to immediately and promptly inform this Honorable Court

of any change in her address or contact number and to submit or report to
the Office of the Clerk of Court copies of all deeds notarized by her.

10. She has not been appointed Notary Public in any other jurisdiction for the
term applied for.

11. Also submitted are petitioner’s 3 passport sized colored photographs with
light background, taken not more than 30 days prior to the filing of this
petition;

WHEREFORE, it is most respectfully prayed that:

A certificate of authorization to purchase notarial seal as provided under Section

9, Rule 3 of 2004 Rules on Notarial Practice, and certificate of authority for a
notarial act as provided under Section 1, Rule IX of the same Rules be issued in
favor of the petitioner.

_______________, Philippines, December 05, 2018

__________________________---

2 |3
 VERIFICATION AND CERTIFICATION

I, _--------------------------------, of legal age, married, Filipino and a resident

of ------------------------------------- under oath depose and state that:

a) I am the Petitioner in the above captioned case; I have caused the

preparation of the same;

b) I have read the allegations contained therein; and

c) I certify that they are all true and correct of my personal knowledge
or based on authentic records.

d) That I hereby certify that I have not filed any similar action or
proceeding before the Supreme Court, Court of Appeals or any
other tribunal agency.

e) That I undertake to inform the Honorable Court in case I learn of

pendency of any similar action or proceeding before the Supreme
Court, Court of Appeals, or any other tribunal agency and that
should I lean of any such action or proceeding, I shall inform the
court within five (5) days from my knowledge thereof.

In witness whereof, I have hereunto set my hand this -----------------------at -

-------------------------------, Philippines.

--------------------------------------------
Affiant

SUBSCRIBED AND SWORN to before me, a notary public in and for Iloilo City,
this _____ day of __________ 2019 at Legaspi City, Albay, Philippine, affiant
appearing before me with her - ID No. -------------------------- issued at Quezon
City, Metro Manila and presenting to me a document entitled In Re: PETITION
FOR REAPPOINTMENT AND RECOMMISSION AS NOTARY PUBLIC FOR
AND IN THE PROVINCE OF ALBAY UNDER THE TERRITORIAL
JURISDICTION OF THIS COURT affiant being known to me personally, and who
signed said document in my presence and sworn as to said document that she
understood the contents thereof and that the same was her free and voluntary
act and deed.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2019.

3 |3