PROMISSORY NOTE

I, _______________________, of legal age, Filipino, and a resident of

_________________________________________________________________________,
promise to pay CLEAN EDGE MANPOWER SOLUTIONS, a business organized under
Philippine laws with principal address at Quirino St., Brgy. Sto. Cristo, Angeles City, herein
represented by ________________________________, the principal sum of
_____________________________________, (P___________), without need of demand,
on or before _________________________ as payment for the medical check-up that the
latter incurred regarding my application for employment to their company.

In case I will not continue my application for employment, I will pay an additional
_________________________________ (P___________) as a form of liquidated damages
to them.

_______________________ _______________________
DEBTOR CREDITOR

Signed in the presence of

_______________________ _______________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

ANGELES CITY ) S.S.

BEFORE ME, a Notary Public for and in Angeles City, Pampanga, personally appeared:
NAME IDENTIFICATION NO.
_______________________ _______________________________________
Valid until _______________
_______________________ _______________________________________
Valid until _______________

who represented to me that they are the same persons who signed the executed the foregoing
Promissory Note and acknowledged to me that the same is their free and voluntary act and deed,
for the uses and purposes therein set forth.

I further certify that said Promissory Note consists of 1 page and is signed by the above-
mentioned parties and their witnesses.

IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal in Angeles
City, Pampanga, this ______ day of _____________ 2020.

Doc No.______;
Page No._____;
Book No._____;
Series of 2020