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DEBT ACKNOWLEDGEMENT FORM DEBT ACKNOWLEDGEMENT FORM

I, ____________________________________________ the I, ____________________________________________ the


undersigned, hereby confirm and acknowledge to the Creditor undersigned, hereby confirm and acknowledge to the Creditor
_____________________________________________ that I _____________________________________________ that I
am indebted to said Creditor, in the amount of am indebted to said Creditor, in the amount of
P______________________ PESOS as of the below P______________________ PESOS as of the below
mentioned date. The indebted amount includes any and all mentioned date. The indebted amount includes any and all
legally permitted charges such as accrued interest, up to that legally permitted charges such as accrued interest, up to that
same below mentioned date. same below mentioned date.

I furthermore acknowledge that I have no argument with said I furthermore acknowledge that I have no argument with said
debts which were incurred by myself, and for which I am solely debts which were incurred by myself, and for which I am solely
responsible. This also means that I acknowledge that there are responsible. This also means that I acknowledge that there are
no defenses should said Creditor decide to use this legal form no defenses should said Creditor decide to use this legal form
in a court of law as a confession to judgment – where legally in a court of law as a confession to judgment – where legally
permissible. permissible.

Signed on this _______ day, of the month ______, in the year Signed on this _______ day, of the month ______, in the year
____________. ____________.

_______________________ _______________________
Witness Witness

______________________ ______________________
Debtor Debtor

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