c





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.



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

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