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-and-
WITNESSETH:
I. PAYMENT
That in case the Second Party shall fail to pay the First Party,
an additional One Hundred Pesos (P 100.00) will be added to her
monthly obligation as a form of interest.
That upon full payment of the aforesaid amount by the Second
Party, herein First Party shall release the former from any civil
liability.
______________ ________________
First Party Second Party
TIN No: __________________ Philhealth ID No: _________________
WITNESSES:
_________________________________
____________________________________
________________________________
Attorney