Acknowledgement of Debt

ACKNOWLEDGEMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________________, Filipino, of legal age, single / married to ___________________________with postal address at ___________________________________________________________ witnesseth:

That I amindebtedin the sum of________ (amount in words) __________ PESOS (P: 000,000.000), Philippine Currency, to _________________________________________ also a Filipino, of legal age, single / married to _______________________________________ with postal address at ______________________________________________________.

That I shall pay the sum of _________________________________ PESOS (P 000,000.00) unto the said ____________________________ within a period of (state the repayment period - days/months/years) from the execution hereof , with interest at the rate of (state theinterest ratein words) ( 0.0 %) percent per year.

IN WITNESS WHEREOF I have affixed my signature hereto this _____ day of ____________, 20__ at ___________________________. at___________________________, Philippines.

_____________________________(Printed Name Over Signature)

WITNESSES:

________________________ _______________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)_____________________________ ) SS.

BEFORE ME,a Notary Public, this ____________day of ________________, personally appeared the following:

Name CTC Number Date/Place Issued

(Name ofDebtor) 10000000 January 15, 20__ / Manila

IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place above written.

Notary Public

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