5/12/2014 Free Legal Form: Acknowledgement of Debt

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 Date/Place Issued

(Name of Debtor) 10000000 January 15, 20__ / Manila

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

Notary Public

http://legal-forms.philsite.net/acknowledgement-of-debt.htm 1/2
5/12/2014 Free Legal Form: Acknowledgement of Debt

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

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

http://legal-forms.philsite.net/acknowledgement-of-debt.htm 2/2