ACKNOWLEDGMENT RECEIPT

We, HILARIO G. EQUIPADO, single, FE FRESNIDO, married and JERRY

GARLAN, single, all of legal age, Filipinos and residents of Brgy. Liang, Irosin, Sorsogon
acknowledge to have receive from DERIT RICHARD ROYO, of legal age Filipino, married
and a resident of Brgy. San Vicente Bulan, Sorsogon the sum of FIFTEEN THOUSAND
PESOS (PhP 15,000.00) representing additional assistance in relation to the civil aspect of
the vehicular accident that transpired on 7:55 in the evening of January 17, 2019 at the
National Highway at Brgy. Sisigon, Matnog, Sorsogon by which we were involved.

___________, 2019

HILARIO G. EQUIPADO
Payee
Valid ID _________________

FE FRESNIDO JERRY GARLAN

Payee Payee
Valid ID _________________ OSCA ID with No. 6941

Witnesses

ELVIRA SAN JUAN JASON FRESNIDO

SUBSCRIBED AND SWORN TO before me this _____ day of _________________ at

Bulan, Sorsogon.