PAYMENT MODEL AND INSTRUCTION LETTER

PAY NO. __________

I, __________ (Debtor), of legal age, identified as it appears at the foot of my signature, acting
on my own behalf, by means of this manifest document, the following:

FIRST: What I owe and will pay, unconditionally and jointly, to the order of __________ (Name
of the Creditor) or to the natural or juridical person to whom the aforementioned creditor
assigns or endorses his rights on this account, the certain amount of __________ EUROS.
(_____)

SECOND: That the total payment of the aforementioned obligation will be made in a single
account, on the ______ day of the month of ______ of the year ______ in the dependencies of
_______ (Name of the Creditor) located in the city of ______, or in your bank account No .
______ from the bank ______.

THIRD: That in case of default I will pay ______ or the natural or juridical person to whom said
creditor assigns or endorses his rights, delinquent interest at the highest rate permitted by
law, from the day following the date of enforceability of the present I will pay, and even when
your total payment is made.

FOURTH: I expressly declare excused the protest of the present promissory note and the
judicial or extrajudicial requirements for the constitution in default.

FIFTH: In case there is a place for the judicial or extrajudicial collection of the obligation
contained in this title, the judicial costs and / or the fees that may be incurred for such reason
shall be charged to me.

In record of the foregoing we sign this authorization, on the ______ days of the month of
______ of the year ______.

THE DEBTOR, Mr,

________________________ _________________(name of

First name: creditor)

C.C No: City