DEED OF ACKNOWLEDGMENT OF DEBT

KNOW ALL MEN BY THESE PRESENTS:

WE, _________________ and __________________, of legal ages, Filipinos, both single,

and residents of ____________________, after being duly sworn to in accordance with law,
witnesseth and declare:

That we are indebted in the sum of _____________ (P_____________), Philippine

Currency, to ___________________, who is also of legal age, single / married / widower, and a
resident of _____________________.

That we hereby promise and undertake to pay the said indebtedness unto the said
____________________ within a period of _____________ (_____) months/years/days from
today, in the amount of _____________ (P_____________) monthly/weekly/daily every
_____________ with interest at the rate of _____________ (_____%) per centum per
month/annum until fully paid.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ in

_____________, Philippines.

_________________________ _______________________

Signed in the presence of:

____________________________ ____________________________

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ____________ ) SS.
x-----------------------------------------x

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in _____________, personally appeared

_____________ with competent evidence of identity No. _____________ issued on
_____________ at _____________, and _____________ with competent evidence of identity No.
_____________ issued on _____________ at _____________, both personally known to me or
whom I have identified through competent evidence of identity and who represented to me that their
respective signatures on the foregoing instrument were voluntarily affixed by them for the purposes
stated in the instrument and who declared that they have executed the foregoing instrument as their
free and voluntary act and deed.

This Instrument consists of only one (1) page/s, including this page in which this
acknowledgment is written, duly signed by the parties and their instrumental witnesses on each
and every page hereof.

WITNESS MY HAND AND SEAL this _____________ at _____________, Philippines.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 2016.