____________________

Date

Acknowledgement Receipt

Received from ______________________________________________________

Of ________________________________________________________________

the amount of ___________________________________ only (Php__________)

as full/partial payment for 1 unit_______________________________________

in very good condition which described as follows :

Make & Type :

Motor No. :
Chassis No. :
Plate No. :
File No. :
Cr. No. :

____________________ ____________________

Vendor Vendee

____________________ ____________________

Witness Witness