ACKNOWLEDGEMENT RECEIPT

I, , of legal age, widow and a resident of

___________________________, Philippines, do hereby acknowledge receipt
the sum of THREE HUNDRED THOUSAND PESOS (Php300,000.00) from,
likewise of legal age, single, Filipino and a resident of
____________________________, Philippines;

Said amount above-written is the proceeds of the Real Estate Mortgage

over a parcel of land more particularly described to wit:

“A parcel of land (Lot No. 1811-A, PSD-07-071151, being

a portion of Lot 1811, Cad 235)) Situated at the District of
_________________, Island of Bohol. Bounded on the NW.,
along line 1-2 by Lot 1811-H, Psd-07-071151; and on the NE.,
SE & SW along lines 2-3-4-5-6-7-1 by Lot 1811-G, Psd-07-
071151 Road Lot (3.00 m. wide) containing an area of THREE
HUNDRED THIRTY FOUR (334) square meters more or less”

The Real Estate Mortgage is duly executed between me (Mortgagor) and

_______________________ (Mortgagee) as evidence by a document Real Estate
Mortgage duly notarize by Notary Public _________________ and entered into
his notarial registry under Doc. No. ____, Page No. ____, Book No. ____, Series
of 2021.

Also by virtue of this instrument I likewise acknowledge receipt in the

amount of Twenty Thousand Pesos (Php 20,000.00) and Ten Thousand
Pesos (Php 10,000.00) respectively constituting cash advances from Jocelyn
Pahang-Adunga.

IN WITNESS WHEREOF, I hereunto affixed my signature this ____ day

of July, 2021 at the ____________________, Philippines.

Mortgagor/Debtor
Senior Citizen’s ID No. BOL-00068

Signed in the presence of:

Witness Witness
Driver’s License Driver’s License