(Acknowledgment of Debt)

DEED OF ACKNOWLEDGMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, _____________, of legal age, Filipino, (single / married / widow), and a

resident of _____________, after being duly sworn to in accordance with law,
witnesseth and declare:
That I am indebted in the sum of _____________ (P_____________),
Philippine Currency, to _____________, who is also of legal age, (single /
married / widow), and a resident of _____________.
That I hereby promise and undertake to pay the said indebtedness unto the
said _____________ within a period of _____________ (_____)
(months/years/days) from today, in the amount of _____________
(P_____________) (monthly/daily) every _____________ with interest at
the rate of _____________ (_____%) per centum per (month/annum) until
fully paid.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in
_____________, Philippines.

AFFIANT

SIGNED IN THE PRESENCE OF:

_________________ __________________

(ACKNOWLEDGMENT)