I, __________________ (Obligee) of Brgy.

Lucero, Jamindan, Capiz,

agrees and promises to pay
___________________________________, Jr. (Obligor)
The sum of TEN THOUSAND PESOS (P10, 000.00) for the reimbursement
of the medical expenses on May 04, 2019.
I also promise to pay the sum of FIFTEEN THOUSAND PESOS (P15,
000.00) on July 06, 2019.

If this Note is in default and is placed for collection, the Obligee shall
be liable under the penalty of law.

_____________________________________
Obligee

________________________________
Obligor

SIGNED IN THE PRESENCE OF:

1. _____________________ 2. ______________________