ACKNOWLEDGEMENT RECEIPT

Date: ________________

Received the amount of _____________________________________________

PESOS (____________), Philippine Currency, from ___________________________
representing FULL PAYMENT for the TRANSFER OF TITLE a parcel of land covered
by Transfer Certificate of Title No. T-__________________ of the Registry of Deeds
for the Province of Laguna, situated in
________________________________________ containing an area of
___________________________________ (_______) SQUARE METERS.

_____________________
Recipient

Conforme:

______________________

SIGNED IN THE PRESENCE OF:

__________________ __________________