Notary Public Rules, 2063

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Rules Relating to Notary Public

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Notary Public Rules, 2063
In exercising the power conferred by Section 44 of the Notary Public Act,
2063, the Notary Public Council has framed the following Rules,
1. Short Title and Commencement: (1) These rules may be called the
"Notary Public Rules, 2063."
(2) These Rules shall come into force immediately.
2. Definitions: In these Rules, unless the subject and context otherwise
requires,-
(a) "Act" means the Notary Public Act, 2063.
(b) "Document to be used in a foreign country" means the document or
paper necessary as per law of a particular country for the sake of any
work and action in a foreign country.
Chapter-One
Provision Relating to Meeting and Function of the Council
3. Meeting of the Council: (1) Meeting of the Council shall be held as
required.
(2) Meeting of the Council shall be held at the venu and time as
decided by the chairperson.
(3) At least Three days before the holding a meeting, the Secretary
of the Council shall notify all the members about the meeting stating
agenda, venue and time of the meeting. If a meeting is to be held all of
sudden for any reasons such a meeting may be held giving notice of
reasonable time.


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(4) Meeting shall be chaired by the chairperson of the Council and in
his/her absence it shall be chaired by the president of Nepal Bar
Association.
(5) The quorum of meeting shall be deemed constituted if at least
Five members are present.
(6) In the meeting of the Council decision of the majority shall be
prevailed and in case of a tie the chairperson of the meeting shall use
casting vote.
(7) The decision of the meeting of the Council shall be recorded in a
separate minute-book and it shall be verified by the person who chairs the
meeting.
(8) The allowance to be obtained by the members for participation in
the meeting of Council shall be as fixed by the Council.
4. Functions of the Council: In addition to the functions provided in the
Act, the Council shall have the following functions:-
(a) To approve the budget of the Council.
(b) To make arrangements to protect and promote the property of the
Council.
(c) To provide direction to the Secretary in relation to the functions and
actions of the Council.
(d) To perform other functions to be performed by Council.
Chapter-Two
Provisions Relating to Secretary
5. Provisions relating to Appointment of Secretary: (1) To appoint the
Secretary of the Council pursuant to Sub-section (2) of Section 7, the


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Council shall have to call application publicly from the persons who are
qualified pursuant to the Act, providing Thirty days time and stating
remuneration, terms and conditions of the service.
(2) After verifying the application received pursuant to Sub-rule (1),
the applicants who seemed qualified shall be taken written examination
based on the curriculum as designed by the Council.
(3) At least Three examinees who obtain highest marks in the
examination held pursuant to Sub-rule (1) shall be sel cted for interview.
(4) A person who secures highest score in written examination held
pursuant to Sub-rule (1) and interview held pursuant to Sub-rule (3) shall be
selected by the Council to appoint for the post of secretary and other Two
persons in the order of their merit shall be listed as alternative candidates
by the Council.
(5) The notice of selection pursuant to Sub-rule (4) shall be
published publicly by the Council.
(6) The person who has been selected pursuant to Sub-rule (4) shall
have to be appeared before the Council within Fifteen days along with the
appointment letter from the date of notice published pursuant to Sub-rule
(5). If such person does not appear in that period, the Council may appoint
secretary from the alternative list based on the merit.
(7) If the post of the secretary filled pursuant to Sub-rule (6) vacates
in any way within Six months from the date of publication of result, in such
case one shall be appointed from among the candidates lis ed in alternative
list based on the merit.
(8) If the post of the secretary is vacated after th period referred to
in Sub-rule (7) such post shall be fulfilled following the procedure as
mentioned in this Rule.


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(9) If no application is received within the period as referred to in Sub-
rule (1), the Council shall call it again for applications providing
Seven days period and if no applications is received on such call or
if the applicants are not found fit, then the Council may appoint the
secretary through negotiation.
(10) Remuneration of the secretary shall be fixed by the Council and shall
not be less than the basic pay scale of non-technical Second class
Gazetted Officer of Nepal Civil Service.
(11) The Secretary shall enjoy leave and other facilities as determined by
the Council.
(12) Notwithstanding anything contained in this Rule, Council may
provide additional facility to the officer who is designated pursuant
to Sub-section (3) of Section 7 of the Act.
6. Functions, Duties and Powers of Secretary: In addition to the
provision of the Act, there shall be the following functions, duties and
powers of the secretary:-
(a) To implement or cause to implement the decisions and directions of
the Council.
(b) To perform necessary functions to conduct smoothly e functions
and proceedings of the committee formed by the Council.
(c) To perform functions relating to personnel administration and office
management of the Council.
(d) To cause to maintain the Account of the Council up-dated.
(e) To maintain the record of Notary Public safe and up-dated.
(f) To prepare the budget of the Council and submit it before the
Council for approval.


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(g) To prepare proposal and programme relating to the functions to be
performed by the Council and to present it before th Council for
approval.
(h) To do other functions as prescribed by the Council.
Chapter-Three
Provisions Relating to Examination, Certificate
and Seal of the Notary Public
7. Examination and Curricular of the Notary Public: (1) Examination
of Notary Public to be conducted pursuant to Section 11 of the Act, shall be
conducted or cause to be conducted by the Council at least once in a year.
(2) While conducting or causing to be conducted the examination
pursuant to Sub-rule (1), it shall be conducted pursuant to the terms and
procedure as specified by the Council.
(3) Examination to be conducted pursuant to Sub-rule (2) shall be
conducted in written form. The weightage of score of the written
examination shall be as determined by the Council.
(4) For the sake of conducting examination pursuant to Sub-rule (1),
the Council may form a Three member committee in the convenorship of
any of its member including an expert of the related subject.
(5) Other functions and procedure relating to meeting of the
committee formed pursuant to Sub-rule (4) shall be as determined by the
Council.
8. To Publish Notice for an Examination: (1) To conduct an examination
pursuant to Rule 7, the Council shall publish a Thirty days public notice
stating venue and date of the examination therein.


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(2) A candidate who intends to appear in the examintio as referred
to in Sub-section (1) shall submit an application in a format as referred to in
Scheduled-1 along with One Thousand Rupees as an examination fees.
9. To Apply: (1) Except to obtain a certificate pursuant to Section 11 of the
Act, a person who is interested to practice as a Notary Public shall apply
before the Council in a format as referred to in Schedule-1 to obtain
certificate.
(2) While submitting application pursuant to Sub-section (1), one
shall pay Five Hundred Rupees as fees.
10. Formation of Recommendation Committee : (1) For the purpose of
Sub-section (2) of Section 14 of the Act, there shall be a committee in the
Council having following members :-
(a) Member of the Council as
designated by the Council - Coordinator
(b) A first class Gazatted officer of
Nepal Judicial Service as
prescribed by the Council - Member
(c) Representative of Nepal Bar
Association - Member
(2) The secretary shall function as member-secretary of the
committee formed pursuant to Sub-rule (1).
(3) Procedures relation to the meeting of the Committee formed
pursuant to Sub-section (1) shall be as determined by the Council.
(4) Meeting allowance of the members of the recommendation
committee shall be as fixed by the Council.


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11. Format of License of Notary Public: Format of a certificate of Notary
Public shall be as referred to in Schedule-1.
12. Certificate Fee: A person who is qualified to obtain certificate of a
Notary Public shall pay Five Thousand Rupees as a certifi ate fee.
13. Renewal of Certificate: (1) A Notary Public shall make an application to
the Council along with Five Thousand Rupees as a fee to renew the
certificate pursuant to Section 16 of Act.
(2) If an application is received pursuant to Sub-section (1), the
Council may renew the certificate upon making investigation whether the
Notary Public has committed official misconduct and upon examining
additional evidence as per-necessity if it deems it appropriate.
(3) The validity of renewal made pursuant to Sub-rule (2) shall be
Five years.
14. Provision Relating to Deposit: (1) When a Notary Public pays the
deposit as prescribed in Section 17 of the Act in cash then the Council shall
receive and deposit it in a separate account.
(2) Notary Public who submits a Bank-guarantee shall submit such a
Bank guarantee as per the terms set out by the Council.
(3) While fixing terms and conditions pursuant to Sub-rule (2), there
shall be a condition inter alia that it shall be paid immediately at the time of
demand of the Council. The validity period of Bank guarantee shall be Six
years.
(4) The deposit which is deposited pursuant to Section 17 of the Act
shall be used only for the purpose of compensation if it is to be paid in the
case of official misconduct of the Notary Public.


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(5) A person, who is entitled for compensation pursuant to Sub-rule
(4), shall apply before the Council within Six months from the date of the
final decision or order delivered for compensation.
(6) After receiving an application pursuant to Sub-r le (4), the
Council shall pay the compensation amount to the ext nt of the deposited
amount.
(7) Deposit amount pursuant to the Act and these Rul s shall be paid
back to the Notary Public by the Council on following conditions:
(a) If the Notary Public dies or
(b) If the Notary Public does not renew the license or files
application to cancel the license voluntarily.
(8) Notwithstanding anything contained in Sub-rule (7), if any claim
for compensation against the Notary Public is pending before his/her death,
or renewal of certificate or cancellation of his/her c rtificate, in such a case,
the deposit amount shall be paid back if the final decision relating to the
claim does not decides for compensation.
(9) While paying back the deposit amount of a deceased Notary
Public on the basis of Clause (a) of Sub-rule (7) it shall be paid to the close
relative as referred to in Rule 2.
15. Oath: (1) A person, who has obtained certificate and intends to practice in
a district upon establishing an office of a Notary Public, shall have to take
oath before that district judge of the same district in the format as referred
to in Schedule-3.
(2) The document of an oath pursuant to Sub-rule (1) shall be send
by the concerned District Court to the Council and such document shall be
kept by the Council on the record of concerned Notary Public.


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16. Seal of the Notary Public: (1) The format of the Seal of a Notary Public
shall be as referred to in Schedule-4.
(2) The Council shall cause to prepare the Seal as referred to in Sub-
rule (1).
(3) A person who has obtained the certificate of a Notary Public who
intends to obtain a Seal pursuant to Sub-rule (1) shall apply to the Council
and if an application is so received, the Council shall make available such a
Seal upon collecting the cost as it has been fixed.
(4) A Notary Public, who has taken a Seal pursuant to this Rule,
shall inform to the Council if it lost or it becomes useless and the Council
shall make available another Seal upon collecting cost therefor.
(5) If, the Notary Public does not want to practice as a Notary
Public, he/she shall return the Seal to the Council.
Chapter-Four
Provision Relating to Certification of Document, Translation of
Paper and Verification of Copy of an Original Document
17. Procedure to Certification of Document: (1) Whosoever is interested
for certification of a document shall apply in the format as referred to in
Schedule-5 along with the following documents:-
(a) Copy of citizenship certificate or passport.
(b) If there is no citizenship certificate or passport then
applicant's identity card having recent photograph,
signature, address, age, surname and name or letter
sticking photograph and stating above details certifi d
by Village Development Committee or concerning


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ward office of municipality where applicant resides or
any identity card which may satisfy the Notary Public
and in the case of a foreigner a paper showing identity
certified by the concerned embassy.
(c) Relationship verification paper, if so required.
(d) If someone wants to certify in the capacity of an agent
power of attorney or letter of authority for certification
and two copies of documents intended to be certified.
(2) Notary Public shall register the application received pursuant to
Sub-rule (1) in the document certification Register.
(3) Before certifying the document, Notary Public shall read out the
statement of the document to be heard and communicate the meaning to
applicant who signs on document and shall keep the paper (memo) so
prepared in the file.
(4) Notary Public shall cause to sign the witness of the applicant in
the document to be certified or in a paper as referr d to in Sub-rule (3) or in
a separate paper.
(5) If the document produced for certification is to be submitted in
any court or office or it is an affidavit, in such a case, Notary Public shall
cause for an oath pursuant to Schedule-6 of the applic nt who puts
signature on the document.
(6) After an oath pursuant to Sub-rule (5), Notary Public shall sign
and put seal at the end of the document along with the statement as referred
to in Schedule-7.
(7) While certifying documents except as stated in Sub-Rule (5), the
Notary Public shall sign at the end of the document or in a separate paper
writing the statement that the matter written in the document is true and if it


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is proved false he or she shall be responsible pursuant to the law and shall
cause to put signature of the applicant pursuant to Schedule-8.
(8) While writing name and surname by the Notary Public pursuant
to Sub-rule (5) or (6), he/she shall have to write th name and surname as
stated in the certificate.
(9) If the document produced for certification is relating to lease,
rent, transfer of title, sale and purchase and salede d of immovable
property, Notary Public shall confirm whether or not that immoveable
property is under the title of the person who put signature on the deed as
well as verifying whether or not that property is alre dy leased or freezed in
any way by any office and also verify land ownership certificate, receipt of
revenue and other necessary matters.
(10)While certifying the statement of the document relating to the
transfer of immoveable property, Notary Public shall certify more than Two
copies of the document as stated in prevailing law and in other condition at
least Two copies shall be certified.
(11) The Notary Public shall mention the serial number of
certification on the certified document as it appears in the Register-Book of
the office.
18. Procedure to Translate Paper : (1) Whosoever is interested to translate
a paper shall have to apply in a format as referred to in Schedule-9 before
the Notary Public along with true copy, copy thereof and other paper which
shows his/her identity.
(2) Application received pursuant to Sub-rule (1) shall be registered
in the Translation Register by the Notary Public.
(3) The Notary Public may translate the paper if there is reasonable
ground to believe that the paper is true and authentic.


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(4) Notary Public shall put registration number in each translated
document as referred to in Sub-rule (2).
(5) Notary Public shall put signature on translated document or
paper as referred to in Schedule-10.
19. Procedure of Verification (Attestation): (1) Whosever wants to verify
(attested) any paper shall have to apply in the format as referred to in
Schedule-11 before the Notary Public along with true copy, one additional
copy along with the copies required for verification and paper which shows
his/her identity.
(2) Application received pursuant to Sub-rule (1) shall be registered
in a separate Register-Book by the Notary Public.
(3) Confirming whether or not the paper to be verifi d is true if
necessary, the Notary Public may make a paper (memo) from the applicant
stating that "the copy is as good as the original copy."
(4) If the paper submitted pursuant to Sub-rule (1) is found authentic
upon an inquiry pursuant to Sub-Rule (3), the Notary Public may verify
such copy of the paper as referred to in Schedule-12.
(5) A verified copy pursuant to this Rule shall be kept safely in the
office by the Notary Public upto a period of Five years.
20. Fee of a Notary Public: Notary Public may charge following
remunerations for the following functions:-
(a) For certification of document not exceeding Five
Hundred Rupees per document.
(b) For translation :-
(1) Document in a format such as citizenship
certificate, land ownership registration


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certificate, birth, death and marriage registration
certificates not exceeding One Hundred Fifty
Rupees per paper.
(2) Legal document, decision or order of a court,
statute of corporate body or other similar paper
not exceeding Five Hundred Rupees per page.
(3) Paper except otherwise provided in Sub-clauses
(1) and (2), recommendation letter of local body
and other similar paper not exceeding Two
Hundred Rupees.
(c) Verification of the copy of a document not exceeding
Fifty Rupees per paper.
(2) Upon receiving remuneration by the Notary Public pursuant to
Sub-rule (1), receipt therefor shall be given to the concerned person and the
record thereof shall be updated in register book accordingly.
Chapter-5
Miscellaneous
21. Matters to be Shown in Register Book: (1) In the Register-Book
relating certification of the document, Notary Public shall put page number
and Seal stating the following matters :
(a) Date of submission of application for the certificat on
document.
(b) Name of the person, surname, age, address,
photograph and thumb impressions of both thumbs
who put signature on document,


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(c) Name of witness, surname, age, address signature and
thumb impressions of both hands
(d) Fee received for certification,
(e) Date of certification of document.
(2) In the Translation Register-Book, the Notary Public shall put
page number and seal on every page and state the following matters:
(a) The date of application submitted to translate th
document.
(b) Name, surname, age and address of the person wh
request for translation of the document or paper.
(c) Page number and subject of the translated document.
(d) Fee for translation.
(e) Date of translation done for applicant.
(3) In the Verification Register-Book, the Notary shall put page
number and seal on every page upon stating the following matters:
(a) Name, surname, address and age of the person wh has
requested for verification of the documents.
(b) Page number and subject of verified document.
(c) Fee for verification.
(d) Date of document verification.
(4) After mentioning matters in the Record Book to be maintained
pursuant to Sub-rules (1), (2) and (3), Notary Public shall put his/her full
signature on the top and bottom of all pages of the Register Book.
22. File to be Submitted: (1) If a Notary Public is not in a position to
continue his/her profession he/she him/herself or in a case of his/her death


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his/her heir shall submit the files as referred to in Sub-section (4) of Section
24 of the Act, to the Council.
(2)The Council, upon examining whether the file received pursuant
to Sub-rule (1) is to be kept safely or not, may destroy it after Five years
from the date of its arrival, if not necessary to keep it safely.
23. Matters to be Stated in the Report: (1) Notary Public shall state the
following matters in the report to be submitted pursuant to Section 25 of the
Act:-
(a) Name and surname of Notary Public.
(b) Certificate number.
(c) Validity date of certificate.
(d) Name, surname, age and address of the person
requested for translation and certification of document
or verification of papers.
(e) Subject, nature and number of certified document,
translated paper or verified paper.
(f) Fee received by Notary Public.
(2) The Notary Public, who does certification of document relating
to transfer of title of immovable property, shall state the subject of title
transfer, measurement of immoveable property and amount stated in the
document in addition to the details mentioned in monthly report to be
submitted pursuant to Sub-rule (1).
24. Descriptions to be Mentioned in the Record of Notary Public: The
Council shall mention the name, surname, address (permanent,
professional), age and contact telephone number, copy of the certificate of
academic qualification, copy of law practitioners license, date of expiry of


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the certificate of Notary Public, date of renewal of the certificate of Notary
Public and other necessary descriptions of the Notary Public in the record
of every Notary Public.
25. Provision Relating to Inquiry of complains: (1) The Council may form a
Three member inquiry committee, if so required, in the convenership of any
of its member to inquire the complain received pursuant to Section 32 of
the Act.
(2) The committee formed pursuant to Sub-rule (1) may ask or
inquire or demand other evidence from the concerned Notary Public.
(3) If the Council or the committee, in relation to an inquiry pursuant
to the Act or these Rules, orders to submit clarification or information, the
concerned Notary Public shall submit clarification r information along
with evidence and proof to the Council within the time-frame given by the
Council or Committee.
(4) The committee formed pursuant to Sub-rule (1), upon completing
inquiry and investigation pursuant to Sub-rule (2),shall submit its report to
the Council along with its opinion.
(5) After submission of the report pursuant to Sub-r le (4) by the
Committee formed pursuant to Sub-rule (1), the Council shall decide, upon
considering the report and proof and evidence, whether the Notary Public
has committed official misconduct or not.
(6) While making decision pursuant to Sub-rule (5),if it is found that
Notary Public has committed official misconduct, the Council shall cancel
his/her certificate pursuant to Section 18 of the Act.
(7) While making decision pursuant to Sub-rule (5),if it is found that
no official misconduct has been committed, suspension hall be ipso facto
cancelled from the date of such decision.


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26. Close Relation: For the purpose of Clause (e) of section 20 of Act, close
relatives shall mean father, mother, husband or wife son, daughter,
grandson, granddaughter, elder sister, younger sister, elder brother, younger
brother, nephew nice, daughter and son of sister, grandfather, grandmother
of Notary Public and other relatives as determined by the Council.









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Schedule-1
(Related to Rule 9)
...................................................
To the Chairperson,
Nepal Notary Public Council,
Kathmandu
Subject: Application for the certificate of Notary Public
Sir,
Whereas, continuously practicing as a legal practitioner since …………../
retired from the post of Nepal judicial service, I am desirous to work as
a.....................in the capacity of Notary Public and I have passed the examination
of Notary Public and therefore, I am applying to obtain the certificate of Notary
Public enclosing necessary papers and fees.
Name and Surname:
Permanent Address:
District and place to work as a Notary Public:
Contact address and telephone number, if any:
Copy of the certificate of academic qualification,
Copy of the license of a law practitioner,
Copy of the citizenship certificate,
For retired officer any evidence which clearly shows his/her retirement,
Two copies of photograph,
Name and Surname to be written as a Notary Public,
Specimen of full signature,
Date: Signature of applicant



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Schedule-2
(Related to Rule 11)
Nepal Notary Public Council
Certificate No.
Notary public Certificate

Pursuant to a decision made by the Council on …………… this
certificate is conferred on Mr./Ms/Mrs. ……………………… son/daughter of
……………..permanent resident of …………….. Ward no. …………….. of
municipality metropolitan city/sub-metropolitan city/village
……………. Development committee ………… district after having been
enrolled his/her name as a/an ……………… under the Notary Public Act, 2006 to
do ………………..

………………. ……………
Secretary Chairperson

Seal of the Council
Date of Issue (A.D.):-



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Schedule-3
(Related to Rule 15)
Format of Oath Taken by Notary Public

I ……………… Notary Public certificate no. ……………., Notary Public
of …………… district.....................swear in the name of God/I solemnly affirm
that while practicing as a Notary Public, I shall practice subject to the Notary
Public Act, 2063 and Rules thereunder and other prevailing laws to the extent
possible of my knowledge, wisdom, rational and qualific tion without any bias,
anger, reservation, prejudice and partiality against a yone and with honesty and
impartiality.

Signature of District Judge
Name and Surname:
Date:

Signature of Notary Public
Name, Surname:
Certificate No. :
Signature :
Date:



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Schedule-4
(Related to Rule 16)
Seal of Notary Public





















Name :
……………………….
Certificate No. :
District
PUBLIC
NE
PA
L





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Schedule-5
(Related to Sub-rule (1) of Rule 17)
Format of Application for Certification of Document

To the Notary Public
District ………………

Subject: In Relation to Certification of Document

I, hereby, apply for certification of following documents along with the fees
to be paid as per Rule:
(a) Documents
1.
2.
(b) Papers which show that the documents are related to the applicant
1.
2.
3.
Applicant's name, surname:
Address:
Signature:
Date:


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Schedule-6
(Related to Sub-rule (5) of Rule 17)
Format of Oath to be Administered by the Notary Public)

I ……..aged…………years, a resident of...............................…………..
grandson/granddaughter of..............………...……son/daughter of.………….....…,
in presence of Notary Public Mr./Ms./Mrs.…………… (Certificate no. ) do
swear in the name of God/Solemnly affirm and declare that the content of this
document is true and correct. I shall personally be liable under law in force, if the
content is found otherwise.

Signature:
Date:


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Schedule-7
(Related to Sub-rule (6) of Rule 17)
Form of Verification of Document for Administering Oath
by the Notary Public

The applicant Mr. /Ms. /Mrs. ……………….. is personally known to me or
on verification of the submitted documents and on interview of his or her witness
(Name, surname, age and address of the witness) it has been found that his/her
personal details are found to be true and correct. I, hereby, verify that he/she has
taken oath in my presence and has signed in this document in presence of the said
witness on ………………. date.

Signature:
Name:
Date:
Certificate number of the Notary Public:
Date of expiry of certificate:

Seal of the Notary Public



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Schedule-8
(Related to Sub-rule (7) of Rule 17)
Form of Verification of Document by Administering Oath

The applicant Mr. /Ms. /Mrs. ……………….........is personally known to
me or on verification of the submitted documents and o interview of his or her
witness (Name, surname, age and address of the witnss) it has been found that
his/her personal details are found to be true and corre t. I, hereby, verify that
he/she has signed in this document in presence of the said witness on
………………. date.

Signature:
Name:
Date:
Certificate number of the Notary Public:
Date of expiry of certificate:
Seal of the Notary Public:



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Schedule-9
(Related to Sub-rule (1) of Rule 18)
Form of Application for Translation

To the Notary Public
……………… District

Subject: In Relation to Translation

I am applying enclosing the fees to be paid as per Rule to translate the
following documents or papers from …………… language to ……….. language.
(a) Documents
1.
2.
3.
(b) Papers which show that papers are related to the applicant
1.
2.
3.
Name and surname of applicant
Address:
Signature:
Date:


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Schedule-10
(Related to Sub-rule (5) of Rule 18)
(Format of Translation Copy of Document)

"The translation copy is true and verified."

Signature:
Name/Surname:
Date:
Certificate number of the Notary Public:
Date of expiry of certificate:
Seal of the Notary Public:













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Schedule-11
(Related to Sub-rule (1) of Rule 19)
Form of Application for Verification of Copy of Document

To,
The Notary Public,
……………… District
Subject: In Relation to verification of document.

I am applying enclosing the fees to be paid as per Rule for verification of
the following papers or documents:
(a) Papers
1.
2.
3.
4.
5.
(b) Papers which shows that the papers are related to the applicant
(c) Rs. …………… fee to be paid is along with it.
Name and surname of applicant:
Address:
Signature:
Date:


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Schedule-12
(Related to Sub-rule (4) of Rule 19)
Form of Verification of Copy of Document
Verification of true copy of original
Name :
Surname:
Signature :
Date:
Certificate number of the Notary Public:
Date of expiry of certificate:
Seal of the Notary Public: