ACKNOWLEDGMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________________, Filipino, of legal age, single / married to

___________________________with postal address at
___________________________________________________________ witnesseth:

That I am indebted in the sum of________ (amount in words) __________ PESOS

(P: 000,000.000), Philippine Currency, to
_________________________________________ also a Filipino, of legal age, single /
married to _______________________________________ with postal address at
______________________________________________________.

That I shall pay the sum of _________________________________ PESOS (P

000,000.00) unto the said ____________________________ within a period of (state
the repayment period - days/months/years) from the execution hereof , with
interest at the rate of (state the interest rate in words) ( 0.0 %) percent per year.

IN WITNESS WHEREOF I have affixed my signature hereto this _____ day of

____________, 20__ at ___________________________.
at___________________________, Philippines.

_____________________________
(Printed Name Over Signature)

WITNESSES:

________________________ _______________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) SS.

BEFORE ME, a Notary Public, this ____________day of ________________,

personally appeared the following:
Name CTC Number Date/Place Issued

(Name of Debtor) 10000000 January 15, 20__ / Manila

IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place
above written.

Notary Public

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