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That I am indebted in the sum of________ (amount in words) __________ PESOS (P:
000,000.000), Philippine Currency, to _________________________________________ also a
Filipino, of legal age, single / married to _______________________________________ with postal
address at ______________________________________________________.
IN WITNESS WHEREOF I have affixed my signature hereto this _____ day of ____________,
20__ at ___________________________. at___________________________, Philippines.
_____________________________
(Printed Name Over Signature)
WITNESSES:
________________________ _______________________
ACKNOWLEDGEMENT
IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place above
written.
Notary Public