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Level 1 Certification Application Form

This document is an application by Dianne Medel S. Gumawid for a Level 1 Certification under the Law Student Practice Rule 138-A of the Rules of Court. The application provides biographical information about the applicant and states that the applicant has paid the necessary fees and will abide by the limitations and obligations of the certification. The applicant prays that the application be granted and the certification be issued.

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Dianne Medel Gumawid
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13 views3 pages

Level 1 Certification Application Form

This document is an application by Dianne Medel S. Gumawid for a Level 1 Certification under the Law Student Practice Rule 138-A of the Rules of Court. The application provides biographical information about the applicant and states that the applicant has paid the necessary fees and will abide by the limitations and obligations of the certification. The applicant prays that the application be granted and the certification be issued.

Uploaded by

Dianne Medel Gumawid
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT


FIRST JUDICIAL REGION
Dagupan City, Pangasinan

OFFICE OF THE EXECUTIVE JUDGE

In Re: Application for Level 1


Certification under the Law Student
Practice, Rule 138-A of the Rules of     
Court,
Application No. _____________

GUMAWID, DIANNE MEDEL S.


Applicant.
x--------------------------------------------
x

APPLICATION

WITH ALL DUE RESPECT TO THE HONORABLE OFFICE OF


THE EXECUTIVE JUDGE.

The undersigned to the Honorable Office of the Executive Judge most


respectfully state that:

1. Undersigned is of legal age, Filipino citizen, and a resident of #45 Ayusip


road Bonuan Boquig Dagupan City, Pangasinan.

2. Undersigned is currently enrolled at Lyceum Northwestern University,


Dagupan City, Pangasinan, College of Law.

3. Undersigned will complete all my first-year courses for Academic Year


2022-2023 and will enroll in the clinical legal education program of
Lyceum Northwestern University, Dagupan City, Pangasinan for the first
semester of academic year 2022-2023.

4. Undersigned is fully aware and will abide with the limitations under
Sections 4, and the duties and obligations under Section 6 - 8 of Rule
138-A of the Rules of Court.

5. Undersigned have paid the necessary fees under Section 21(1) of Rule
141 of the Rules of Court for the issuance of the Level 1 Certification.
Attached herein is a copy of the official receipt as proof of payment
marked herewith as Annex A.
PRAYER

WHEREFORE, it is most respectfully prayed that this applicated be


GRANTED and that a LEVEL 1 CERTIFICATION be issued.

SUCH OTHER RELIEFS AND REMEDIES, just and equitable under the
premises are likewise prayed for.

Dagupan City, Pangasinan. 24 September 2022.

DIANNE MEDEL S. GUMAWID


VERIFICATION

I, DIANNE MEDEL S. GUMAWID, of legal age, single, Filipino citizen


and a resident of #45 Ayusip road Bonuan Boquig., Dagupan City, Pangasinan
under oath declare that the above statements are personally made by me and are
true and correct based on my personal knowledge and authentic records.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my


signature this ____________________ in Dagupan City, Pangasinan.

DIANNE MEDEL S. GUMAWID


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, on the date and place


above stated, personally appeared the affiant made known to me through his
competent evidence of identity indicated below his name who executed this
affidavit who avowed under penalty of law to the truth of the contents of the above
affidavit.

WITNESS MY HAND AND SEAL.

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