REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SAMAR )S.S

CITY OF CATBALOGAN )

ACKNOWLEDGMENT RECEIPT

KNOW ALL MEN BY THESE PRESENTS:

I, __________________, of legal age, single/married, Filipino and a resident of

______________, have acknowledge receipt of the sum of TWENTY FIVE
THOUSAND PESOS (Php25,000.00), Philippine Currency, from CRESENCIO T.
VOZ, JR., of legal age, widow, Filipino and a resident of Gandara, Samar, as full
payment or Partial payment of my loan or indebtedness.

IN WITNESS WHEREOF, I have hereunto affixed my signatures this 8 th day of

April 2021 at Catbalogan City.

CIELITO A. SIAZON
Borrower

SIGNED IN THE PRESENCE OF:

______________________________ __________________________

SUBSCRIBED AND SWORN to before me this 8 th day of April 2021 at

Catbalogan City, affiant exhibited to me his .