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DEED OF ACKNOWLEDGMENT OF DEBT KNOW ALL MEN BY THESE PRESENTS: I, _____________, of legal age, Filipino, (single / married / widow),

and a resident of _____________, after being duly sworn to in accordance with law, witnesseth and declare: That I am indebted in the sum of _____________ (P_____________), Philippine Currency, to _____________, who is also of legal age, (single / married / widow), and a resident of _____________. That I 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/daily) every _____________ with interest at the rate of _____________ (_____%) per centum per (month/annum) until fully paid. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in _____________, Philippines.

AFFIANT

SIGNED IN THE PRESENCE OF:

__________________

__________________

(ACKNOWLEDGMENT)

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