ACKNOWLEDGMENT RECEIPT

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

__________________ hereby acknowledge the receipt of the
____________________________________________________________ from
______________________.

_____________________________________________________________
________________________________________________________________
______________________.

Signed this ___ day of _______2019 at ___________________________,

Philippines.

______________________
Affiant

Signed in the presence of:

__________________ __________________

SUBSCRIBED AND SWORN TO before me this ____ day of _______ 2019,

affiant exhibited to me his _________________as competent evidence of his
identity.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019.