REPUBLIC OF THE PHILIPPINES)

______________________________) S.S
x-------------------------------------------x

ACKNOWLEDGEMENT

I, ___________________________ of legal age, Filipino Citizen with residence and

postal address at ______________________________________ received the amount of
________________________________________________ Philippine Currency from
________________________________(BUYER/S), of legal age, Filipino Citizen with
residence and postal address at
_______________________________________representing _______________ payment
for the purchase of ______________________________________ located at _________
__________________________.

_________________________ ___________________________
Released By Released By
BUYER BUYER

________________________ __ _____________________________
Received By Received By
SELLER SELLER

Subscribed and Sworn to before me this ____________________ at ________________

Affiant exhibiting to me their competent evidence of identity as follows.

_______________________ __________ID No. ____________

_______________________ __________ID No. ____________

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SERIES OF: 2021