ACKNOWLEDGMENT RECEIPT

PhP ___________

I, ____________________, of legal age, married, Filipino, and with

residence at _______________________________, DO HEREBY
ACKNOWLEDGE RECEIPT OF THE SUM OF __________________________
from ________________ as payment for the purchase of my lot covered by TCT
No. _______________.

This _____ of _______________ 2021, in __________________.

Recipient

Conforme:

Payor

Signed in the presence of:

1)_________________________ 2)_________________________

SUBSCRIBED and SWORN to before me this _________ of

____________ 2021, in ________ Philippines. Affiants exhibiting to me their
government issued identification cards, the details of which are indicated below
their names. The affiants avowed to the truthfulness of the foregoing statements.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2021.