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This Installment Agreement (the “Agreement”) is hereby entered into by and between:
___________________________________, of legal age, _______________ citizen,
single/married, with address at __________________________________, hereinafter
referred to as the “FIRST PARTY”;
________________________, a corporation organized and existing under and by virtue
of the laws of the Republic of the Philippines, with principal office at
____________________________, represented by its duly authorized
____________________________, and hereinafter referred to as the “SECOND
Each a “Party”, and collectively, the “Parties”.

WHEREAS, the SECOND PARTY is engaged in the

WHEREAS, the FIRST PARTY desires to avail the services of the SECOND PARTY, the details of which
is attached in this agreement (ANNEX “A”), including the price and terms of service;

WHEREAS, the parties desire to enter into an agreement whereby the FIRST PARTY shall avail of
the procedure through installment and shall pay the SECOND PARTY the sum of the deficiency through a
payment plan according to the terms and conditions herein set forth.

NOW THEREFORE, for and in consideration of the foregoing premises, and the following
covenants, the PARTIES hereby agree as follows:

1. Deficiency Acknowledgment - The FIRST PARTY agrees and acknowledges that it owes the
SECOND PARTY an amount of money equal to the deficiency as defined above. Nothing in this
Payment Agreement is a waiver of any amounts owed and in the event of any breach of this
Agreement by the FIRST PARTY, the SECOND PARTY’s rights to the Deficiency shall not be limited.

2. Payment Plan - The PARTIES hereby agree to the payment plan as described hereunder. The FIRST
PARTY agrees to make the payments to the SECOND PARTY associated with the dates as listed on
the following Payment Plan:

(insert table)

3. Method of Payment - Payments shall be made to the SECOND PARTY in accordance with the
Payment Plan via cash or visa/master card credit card.

4. Release and Indemnification - In consideration for agreeing to this Payment Agreement, the
SECOND PARTY hereby releases any claims against the FIRST PARTY related to the Deficiency as
of the date of this Agreement. However, nothing in this Agreement is meant to release the FIRST
PARTY from its obligation to pay the Deficiency according to the Payment Plan herein set forth or
limit the rights of the SECOND PARTY in collecting said Deficiency.
5. Acceleration upon Breach - In the event that the FIRST PARTY fails to make any payments in
accordance with the Payment Plan, upon reaching ten (10) days after the failure to make any such
prescribed payment, the full amount of the Deficiency shall come immediately due and payable.

6. No Modification Unless in Writing - No modification of this Agreement shall be valid unless in

writing and agreed upon by both Parties.

7. Forfeiture – The treatment shall be available within the timeframe as provided in the attachment
as aforementioned. The FIRST PARTY understands that failure to avail of the treatment within the
time period or validity date shall mean the forfeiture of the remaining sessions, if any.

8. The payment for the treatment are non-refundable and non-convertible and the services are non-

IN WITNESS WHEREOF, the parties have hereunto set their hands and affixed their signatures this
___ day of September, 2019 in the City of _____________________, Philippines.

(First Party) (Second Party)


Operations Manager

Signed in the presence of:

________________________________ ________________________________
(Signature over printed name) (Signature over printed name)



CITY OF __________________)

BEFORE ME, a Notary Public for and in the above jurisdiction, this ______________ personally
Name Valid Government Issued ID Date/Place Issued or Validity

who have satisfactorily proven to me their identity upon presentment of their respective competent
evidence of identity, who acknowledged before me to be the same persons who executed the foregoing
Memorandum of Agreement and further acknowledged to me that the same is their own free and
voluntary act and deed and as well as of the corporations and/or juridical entities they represent, as
indicated above, with full authority to sign in such capacity.

This Installment Agreement consists of three (3) pages including this page where the
Acknowledgment is written and signed by the party together with his instrumental witnesses on each and
every page thereto.

WITNESS MY HAND, this ____ day ________________ in the City of _____________________.

Doc. No. ____; NOTARY PUBLIC

Page No. ____;
Book No. ____;
Series of 2019.