ACKNOWLEDGEMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

I, _____________________, Filipino, of legal age, (single/married), with postal address

at _________________________________ witnesseth:

That I am indebted in the sum of ______________________________ PESOS (amount

in words) PhP _____________________ (amount), Philippine currency, to
___________________, also a Filipino, of legal age, (single/married), with postal address at
_______________________.

That I shall pay the sum of _______________________________ PESOS unto the said
__________________________ within a period of ________________ from the execution
hereof, with interest at the rate of ________ % per year.

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

_____________, 20__ at ___________________, Philippines.

_______________________________________________

PRINTED NAME OVER SIGNATURE

WITNESSES:

________________________ ___________________________