REPUBLIC OF THE PHILIPPINES )

PROVINCE OF )
MUNICIPALITY/CITY OF ) S.S

ACKNOWLEDGMENT RECEIPT

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

___________________ and being the Attorney-in-Fact of _________ and ______________ do
hereby acknowledge receipt of the amount of ___________________ PESOS (Php
_____________) Philippine currency from ______________, likewise of legal age,
single/married, a Filipino citizen and a resident of ______________, representing full payment
of Lot No. ___________ located at ________________ described and covered under TCT No.
__________.

Given this _____ day of ______ 2022, at __________________.

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

______________________________
(Affiant)
(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.

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