ACKNOWLEDGEMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I,
_____________________________,
Filipino,
of
legal
age,
single
/
married
___________________________
with
postal
address
___________________________________________________________ witnesseth:

to
at

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 ____________, 200_
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
(Name of Debtor)

CTC Number
10000000

Date/Place Issued
January 15, 2008 / 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 200_.