On this ______day of ______, in the year 20______, personally appeared before me date month year. On this ______day of ______, in the year 20____, before me,.On this _____ day of ______, in the year 20__, before me,. , personally appeared. An acknowledgment is one of the most common types of notarial acts, but it often confuses Notaries. Here are 5 steps to performing an acknowledgment. A form for the employee to sign acknowledging receipt of the policies. Following are samples of these provisions. Here's a guide to help you understand why you need an acknowledgement statement and how to make yours as effective as possible.