Republic of the Philippines )

) SS.

ACKNOWLEDGEMENT
I __________ , hereby declare to have received ________ from the
________ as __________

That I have received ________ which is __________

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ at

__________.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me on the date and at the place

above written, affiant exhibiting to me her _______ with I.D. number _______
bearing her photo and signature as competent evidence of identity.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2018.