REPUBLIC OF THE PHILIPPINES )

PROVINCE OF )
MUNICIPALITY/CITY OF ) S.S

ACKNOWLEDGEMENT RECEIPT

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

___________________, hereinafter referred to as the SELLER

AND

______________________, of legal age, single/married, a Filipino citizen and a resident

of ___________, hereinafter referred to as the BUYER, hereby witnesseth:

That the SELLER offered to sell the _____________unto herein BUYER which the latter
hereby accepts under the following terms and condition:

1. That the total agreed selling price is _______________ (Php __________);

2. That the payment shall be in a monthly installment basis as follows:

a. The buyer shall pay the seller the amount of ____________ (Php___________) on or
before ____________;
b. Another ____________ (Php _______) to be paid by the buyer unto the seller on or
before_____________;
c. And the last payment of ___________ (Php________) shall be paid by the buyer unto
the seller on or before ________________;
d. Failure of payment on the said date mentioned above will be given 1 month to pay
and incase the buyer still fails to pay on the said grace period, the said personal
property will be repossessed in favor of the SELLER.

3. That it is hereby mutually agreed upon by both parties.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _____ 2022
Laoag City, Ilocos Norte, Philippines.

______________________________ ___________________________
(Seller) (Buyer)
(ID No._______________)

WITNESSES:

______________________________ ______________________________

SUBSCRIBED AND SWORN to before me, in the city/municipality of __________, this

_________ day of 2022 by ___________ with (ID and ID number) issued at _____ on ______
2022.

Doc No.
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Book No.
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