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:

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) SS.

BEFORE ME, a Notary Public for and in the City of ___________________, personally appeared:

Known to me and to me known to be the same persons who executed the foregoing instrument and acknowledged to me that the same are their free act and voluntary deed.

This instrument, consisting of (__) pages, including the page on which this acknowledgment is written, has been signed on the left margin of each and every page thereof by the concerned parties and their witnesses, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL on this ___day of __________________20__ at_______________.

Notary Public

Doc. No. ........;

Page No. .......;

Book No. .......;

Series of 20__.