ACKNOWLEDGEMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, ____________________, Filipino, of legal age, single with postal address at

____________________, witnesseth, that:

1. I am indebted in the sum of _________________ (P: ____________________),

Philippine Currency, to _________________________________________ also a Filipino,
of legal age, with postal address at
________________________________________________________________________
_______________;

2. I shall pay the sum of ________________ (P: ___________________) unto the said
_______________________________________________________ within a period of five
years. In consideration of the said amount, __________________________ undersigned
shall pay 5% interest per annum, to be paid every 31st of December every year.

IN WITNESS WHEREOF, I have affixed my signature hereto this _____ day of

____________, 2019 at ____________________, Philippines.

___________________________

WITNESSES:

________________________ _______________________

Conforme:

______________________
Creditor
 ACKNOWLEDGMENT
Republic of the Philippines }
_______________________ } S. S.

BEFORE ME, a Notary Public for and in _________________ this _____ day of
___________________ 2019, personally appeared the following:

Name Government-Issued ID No. Date and Place of

Issue

both known to me to be the same persons who executed the foregoing Contract and acknowledged
to me that the same is their free voluntary act and deed and likewise that of the corporations which
they respectively represent.

This instrument consisting of ____ pages including this page wherein the acknowledgment
is written and signed by the parties and their witnesses on each and every page hereof.

Notary Public
Doc. No.: _____;
Page No.: _____;
Book No.: _____;
Series of 2019.