ACKNOWLEDGEMENT OF DEBT KNOW ALL MEN BY THESE PRESENTS: I, ______________________________, Filipino, of legal age, single / married to ___________________________with postal address at ___________________________________________________________ witnesseth: That I am indebted in 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 the interest rate in 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 of Debtor) 10000000 January 15, 20__ / Manila IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place above written. Notary Public Doc. No. .......; Page No. .......; Book No. .......; Series of 20__.