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To whom it may concern,

This is to express in writing my inability to pay on time the amount due for my membership
fee amounting to P_____________________. I promise to pay said amount on or before
______________________. I am writing this promissory note stated with my valid reason
____________________.

Furthermore, I am fully aware that subsequent Promissory Notes shall not be accepted
without settling my current due amount.

I hereby affix my signature to this agreement.

Done this ____Day of _________ 20____.

_________________________ _________________________
Student’s Name & Signature Parent/Guardian’s Name & Signature

Year Level: ____________________

Approved by:
MARK ROLAND D. CENA ABEGAIL M. PASCO
GENERAL TREASURER, JPSME-USTP ASSOC. TREASURER, JPSME-USTP

Noted by:
ENGR. REYVENCER T. REYES
MODERATOR, JPSME-USTP

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