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________________________________________ PESOS

(Php ___________), Philippine Currency, to _________________________________________
also a Filipino, of legal age, single / married to _______________________________________
with postal address at __________________________________________________________.

That I shall pay the sum of _____________________________________________ PESOS

(Php _________) unto the said ____________________________ within a period of
________________from the execution hereof , with interest at the rate of _________ percent
per month.

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

______________________________ _______________ ________________________

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 20__.