B.E. No.

:
PB2024-01851
APPLICATION TO TAKE THE 2024 PHILIPPINE BAR EXAMINATIONS
O.R. No:
PREVIOUS TAKER
BAR-PB2024-000001850
PERSONAL INFORMATION
Surname Given Name Middle Name Middle Initial Suffix
Zoleta Princess Diane Gazmen G
Place of Birth Date of Birth (YYYY/MMM/DD) Sex Assigned at Birth
Dampulan, Torrijos, Marinduque 1996/Sep/20 Female
Filipino Citizenship Acquired By Civil Status Prefered Pronoun/s Special Needs
Birth Single She/Her None
(For Married Female Applicant Only)
Maiden Name Spouse's Name
Surname Given Name Middle Name Surname Given Name Middle Name Suffix
N/A N/A N/A N/A N/A N/A N/A
Citizenship N/A
Father's Name Mother's Maiden Name
Surname Given Name Middle Name Suffix Surname Given Name Middle Name Suffix
Zoleta Antonio Fabella Zoleta Wilma Gazmen
Citizenship Filipino Citizenship Filipino
Guardian's Name
Surname Given Name Middle Name Suffix Citizenship
N/A N/A N/A N/A N/A
CONTACT INFORMATION
Permanent Address Present Address [ ] same as permanent address
House/Lot No. Street Subdivision/Village House/Lot No. Street Subdivision/Village
Centro 1 Dampulan Block 11 Lot 38 Eastwood Villa
Barangay City/Municipality Barangay City/Municipality
Dampulan Torrijos San Isidro Rodriguez
Province Region Zip Code Province Region Zip Code
Marinduque MIMAROPA Region 4903 Rizal CALABARZON 1860
Mobile Number Landline Number E-mail Address
09763764846 [email protected]
Person to be notified in case of emergency
Complete Name Relationship to applicant Mobile Number
Francis Neil Zoleta Brother 09151034075
BAR EXAMINATIONS HISTORY
[ ] This is the first time that I am taking the Bar Examinations.
[ ] This is NOT the first time that I am taking the Bar Examinations.
If this is NOT the first time that you have taken the Bar Examinations:
Number of Bar Examinations Taken: 1
Years Taken: 2022
The last Bar Examinations I took was In: 2022
to which I was: [ ] Unconditionally admitted [ ] Conditionally admitted
If conditionally admitted, state the reason/s therefore and state whether the condition was complied with:
N/A
For Refreshers (covered by Section 18, Rule 138 of the Revised Rules of Court, or those who did not pass the Bar Examinations for three [3] or more times):
(1) Re: Compliance with the REFRESHER COURSE
[ ] I have completed the regular fourth year under bona fide professors of the Law School or University where said subjects were taken and completed.
Law School(s) or Universities: N/A
Academic Year: N/A
[ ] I am currently enrolled in fourth year law review classes.
Law School(s) or Universities: N/A
(2) Re: Compliance with the PRE-BAR REVIEW COURSE
[ ] I have completed the Pre-Bar Review Course for the 2024 Philippine Bar Examinations.
Law School or Universitiy: N/A
[ ] I am presently enrolled and regularly attending the Pre-Bar Review Course for the 2024 Philippine Bar Examinations.
Law School or Universitiy: N/A
[ ] I undertake to enroll in a Pre-Bar Review Course for the 2024 Philippine Bar Examinations, upon successful completion of my Refresher Course.

Date Signature
EDUCATIONAL BACKGROUND

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 Degree, Title, or Course Year of
Level Name of School or University
(Include Major) Graduation
Pre-Law New Era University BSBA Legal Management 2016
Law New Era University Juris Doctor 2021
[ ] I completed my Pre-Law studies under the Expanded Tertiary Education Equivalency and Accreditation Program (ETEEAP).
For Graduates of Academic Year 2022-2023 onwards
[ ] I am currently completing / have completed the Clinical Legal Education Program (CLEP), as required by Rule 138-A of
the Revised Rules of Court.
For Graduates of Foreign Law Schools
[ ] I completed my fourth (4)-year Law Course in a Foreign School or University and I took fourth year Bachelor of
Law/Juris Doctor subjects in:
- Law School or University in the Philippines: N/A
- Academic Year: N/A
[ ] I completed my fourth (4)-year Law Course in a Foreign School or University and I am currrently taking my fourth
(4th)- year Bachelor of Law subjects in:
- Law School or University in the Philippines: N/A
- Academic Year: N/A

DISCLOSURE OF RELATIONSHIP
Are you related by consanguinity or affinity within the fourth (4th) civil degree to any incumbent Justice of the Supreme Court, and/or
official or personnel of the Office of the Bar Chairperson, or the Office of the Bar Confidant?
[ ] Yes [ ] No
If Yes, please state the complete name of your relative and your relationship:

DISCLOSURE OF PENDING AND/OR DECIDED CASE(S)

Have you been charged with any act or omission punishable by law, rules or regulations before any Court, Prosecutor's Office or
Agency?
[ ] Yes [ ] No
If Yes, please state the details of the case in the table at the end of the application form.

CONSENT AND UNDERTAKINGS

1. I certify before the Honorable Court that all the statements in this application, as well as the information uploaded to the
BARISTA are true and correct based on my personal knowledge. I am aware that any false or inaccurate information or
misrepresentation on my part shall allow the Office of the Bar Confidant to cancel my application and may likewise constitute as a
ground for disqualification to take the 2024 Philippine Bar Examinations, depending on the stage of discovery but without prejudice
to other sanctions that the Honorable Court may impose.
2. I am morally fit to take the 2024 Philippine Bar Examinations and I undertake to immediately report to the Office of the Bar
Confidant, should any derogatory record be filed against me, from the time of application until the examinations.
3. I undertake to submit to the Office of the Bar Confidant this application form together with the physical copies of the mandatory
requirements as stated in Bar Bulletin No. 2, S. 2024 no later than ten (10) calendar days from the notice of approval of my
application. Further, I undertake to upload and submit the deferred requirements no later than October 15, 2024, if required.
4. I have read the BARISTA Data Privacy Notice for the 2024 Philippine Bar Examinations and I agree on the collection and
processing of my personal information as indicated in the BARISTA.

Date Signature

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Government- or Latest Law School-issued ID:
ID Type: Police Clearance
ID Number: TRAMP020240222023334
Date of Issuance: 2024/Feb/26
Place of Issuance: Marinduque RIGHT THUMBPRINT

Zoleta, Princess Diane Gazmen

SIGNATURE OVER PRINTED NAME

DATE ACCOMPLISHED

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LIST OF PENDING/DECIDED CASES
N/A

Date Signature
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