ACKNOWLEDGEMENT RECEIPT

I, _____________________________________________________, a resident of
___________________________________________________________,borrowed an amount
of________________________________________________________________________from
_______________________________________. Under the express obligation agree to pay the
loan with a 20% interest per month. Failing which, I acknowledge that I shall expressly be liable
in accordance with the law.
Both parties agree on the terms and conditions surrounding this agreement.
IN WITNESS WHEREOF, Signed and dated today on _____________________.

__________________________________ _________________________________
Borrower’s Signature Over Printed Name Lender’s Signature Over Printed Name
SIGNED IN THE PRESENCE OF:

__________________ _____________
___ _______

REPUBLIC OF THE PHILIPPINES ))

CITY OF )S.S

SUBSCIBED AND SWORN TO BEFORE ME , on this day _______________________, at

__________________________.

Doc. No. ________

Book No. ________

Page No. ________

Series of 20_______