REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LAGUNA )
MUNICIPALITY OF SAN PEDRO ) S.S.

ACKNOWLEDGEMENT RECEIPT

This is to acknowledge the receipt of the amount of Fifteen Thousand Pesos

(P15,000.00) from _____________ which represents my share from _______________
Cooperative; Paranaque City.

Furthermore, receipt of the amount of Forty Six Thousand Pesos (P46,000.00)

from _______________ is hereby acknowledged which represents an amount of loan I
borrowed from the above mentioned cooperative.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of August,

2014, in San Pedro, Laguna, Philippines.

___________________________________
<NAME>
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this 28th day of August, 2014 in
San Pedro, Laguna, Philippines, affiants exhibiting to me the following:

NAME ID No.
<NAME>

ATTY. NO CASE
Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.