ACKNOWLEDGE OF DEBT AND PROMISSORY NOTE
KNOW ALL MEN BY THESE PRESENTS:
I/ We ___________________________________________________________of legal
Age /s Filipino/s and resident/s of __________________________________________________
Witnesseth:
That I/ We indebted in the sum of ____________________________________________
__________________________________________(Php ____________) Philippine Currency, to
__________________________________________of legal age, ____________, Filipino and a
Resident of San Alejandro Santa Maria, Pangasinan.
That I/ We bind myself / ourselves to pay the aforesaid DEBT on or before ____________
From the date of this Instrument to the said ___________________________, its his/their heirs
Assigns.
That should I/ We fail to comply herewith, I/ We bind myself / ourselves to pay
LIQUIDATED DAMAGES in the amount of NOT LESS THAN FIVE THOUSAND (Php 5000.00) PESOS,
Philippines Currency, and if this DEBT is brought to Court for collection because of non-
payment, I/We further agree to pay ATTORNEY’S FEES of not less than TWENTY FIVE (25%)
PERCENT of the total amount due;
That as security for the payment of said DEBT I am/ we offering as collateral or security
The following:
That this instrument was read and translated to me/ us in the ilocano dialect and I/ We
Fully understood its contents.
IN WITNESS WHEREOF, I/ we have hereunto set my/ our hands this _________________
At Sta. Maria, Pangasinan.
_____________________________________ ____________________________________
DEBTOR DEBTOR
CTC No. ___________________________ CTC No. ___________________________
Issued on:__________________________ Issued on:__________________________
At ________________________________ At ________________________________
SIGNED IN THE PRESENCE OF:
____________________________________ __________________________________
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF PANGASINAN) S.S
MUNICIPALITY OF _________________)
BEFORE ME, on the date and in the place first above written, personally appeared the
Above mentioned person/s known to me to be the same person/s who executed the foregoing
instrument and who acknowledged to me under oath that the same is his/ her, their free act
and deed.
WITNESS MY HAND AND SEAL
Notary Public
Doc. No. ______________________
Page No. ______________________
Book No. ______________________
Series of ______________________