ACKNOWLEDGEMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________________, Filipino, of legal age, single / married to

___________________________with postal address at
___________________________________________________________ witnesseth:

That I am indebted in the sum of________ (amount in words) __________ PESOS (P:
000,000.000), Philippine Currency, to _________________________________________ also a
Filipino, of legal age, single / married to _______________________________________ with postal
address at ______________________________________________________.

That I shall pay the sum of _________________________________ PESOS (P 000,000.00) unto the
said ____________________________ within a period of (state the repayment period -
days/months/years) from the execution hereof, with interest at the rate of (state the interest
rate in words) (0.0 %) percent per year.
 
IN WITNESS WHEREOF I have affixed my signature hereto this _____ day of ____________, 20__
at ___________________________. at___________________________, Philippines.

 
_____________________________
(Printed Name Over Signature)
 
WITNESSES:
 
________________________          _______________________ 
 
ACKNOWLEDGEMENT
 
REPUBLIC OF THE PHILIPPINES)
_____________________________ )  SS.

BEFORE ME, a Notary Public, this ____day of ________________, personally appeared the
following:
 
    Name                       CTC Number                Date/Place Issued
 
  (Name of Debtor)           10000000            January 15, 20__ / Manila
(Name of Creditor)           10000000               February 24, 20__ / Pasig
 
IN WITNESS  WHEREOF, I have hereunto set my hand the day, year and place above written.
 
              
Notary Public

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