Acknowledgment of Debt

ACKNOWLEDGEMENT OF DEBT

I, ___________________________, Filipino, of legal age, single/married to (name of spouse), and a resident of (address of affiant), after having been duly sworn in accordance with law, hereby depose and say:

(list statements, numbered consecutively)

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines.

_________________________________

(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: (ID type and number), valid from (date) to (date) issued by (issuing authority), personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument.

Notary Public

Doc. No. ……..;
Page No. …….;
Book No. …….;
Series of 2013.