ACKNOWLEDGEMENT RECEIPT

OF INDEBTEDNESS
___________,

____________________________________________, of legal age, Filipino, residing at

_______________________________________________________, do hereby acknowledge the
receipt of the amount of ______________________________________ PESOS (P _________ )
Philippine Currency from ______________________________________, of legal age, Filipino,
and a resident of _______________________________________ as ______________________

IN WITNESS WHEREOF, I am affixing my signature this ________________ at

Muntinlupa City.

Received by: Conforme:

_______________________ _______________________
________ ID No. _________ ________ ID No. _________

SIGNED IN THE PRESENCE OF:

_______________________ _______________________