ACKNOWLEDGEMENT 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

(Name of Debtor)

10000000

Date/Place Issued
January 15, 20__ / Manila

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

Notary Public
Doc. No. .......;

Page No. .......;

Book No. .......;
Series of 20__.