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ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
) S.S.
BEFORE ME, a notary public for and in the City of ___________________, this ____ day of
_______________, 20__, personally came and appeared:
________________________________ _____________________________
OWNER CONTRACTOR
TIN #___________________________ TIN #___________________________
CTC # __________________________ CTC #__________________________
Issued On_______________________ Issued On_______________________
Issued At________________________ Issued At________________________
known to me and to me known to be the same persons who executed the foregoing instrument which
consist of three pages, including this page, acknowledged before me as their free and voluntary act and
deed.
WITNESS MY HAND AND SEAL this _______ day of _____________, 20__.
NOTARY PUBLIC
Doc No.______;
Page No.______;
Book No.______;
Series of 20___.