DATE:___________________________

ADDRESS:__________________________

ACKNOWLEDGMENT RECEIPT

I HEREBY ACKNOWLEDGED THE RECEIPT OF THE AMOUNT OF P___________.OO FROM MR./MS.

____________________________________ AS MY LOAN OBLIGATION PAYABLE WITHIN _______YEARS
OR _____MONTHS FROM THIS DATE. ATTACHED HEREWITH ARE COPY/COPIES OF FOLLOWING
DOCUMENT/S AS MY CO-LATERAL TO THIS LOAN.

___________________________________
Borrower’s name and signature

Republic of the Philippines)

Province of Aklan )
Municipality of Libacao )

SUBSCRIBED AND SWORN TO before me this _____ day of ____________________ 2018 at kalibo,
Aklan, Philippines.

Notary Public