Legal Form - Sample Acknowledgement of Debt ACKNOWLEDGEMENT OF DEBT We, X and Y, both of legal age, Filipino , !e ident of "a!

o, #loilo Cit$, %hilippine , he!eb$ a&'no(ledge that (e a!e indebted in the a)o*nt of TWENTY T+O,-AND %E-O- .% /0,0001002, %hilippine C*!!en&$, to 3, Filipino, of legal age, )a!!ied, !e ident of "a!o #loilo Cit$4 That (e * ed the abo5e6)entioned a)o*nt in !edee)ing the )o!tgage loan of AAA f!o) CCC of La %a7 #loilo Cit$4 That to e&*!e the abo5e6)entioned debt (e, (ith &on ent of aid AAA a!e t*!ning o5e! to aid BBB that #-,3, )oto!&$&le (ith Moto! No1 89E6:::::: and Cha i No1 89E6 :::::: &o5e!ed b$ Ce!tifi&ate of 9egi t!ation No1 ::::::6: #N W#TNE-- W+E9EOF, (e ha5e he!e*nto et o*! hand thi A*g* t ;;, /0;0 in Kalibo, A'lan, %hilippine 1 X Affiant Y Affiant

-,B-C9#BED and -WO9N to befo!e )e thi A*g* t ;;, /0;0 in Kalibo, A'lan, %hilippine 1 Affiant e:hibited to thei! CTC<#D No 1 to p!o5e thei! identit$1 X = /8>?@AAA = #loilo Cit$ = A*g* t ;;, /0;0 Y 6 %!ofe ional D!i5e!B Li&en e No1 F0?6A@600A>;0 "DC Nota!$ %*bli&6 ,ntil De&e)be! D;, Nota!ial Co))i ion No1 ;; ./0;;6

Do&1 No1 ;; 4 /0;/ %age No1 ;; 4 /0;/2 Boo' No1 ;;; 4 -e!ie of /0;; 1 Cit$6;<D</0;; ;;<D0</0;0

ABC -t!eet, "a!o #loilo Cit$ %T9 No1;;;;;;;6%TO, "a!o #loilo 9oll No1 ;;;;; #B% O9 No1 ;;;;;;6