REPUBLIC OF THE PHILIPPINES )

City/Municipality of _____________ )
Province of Bohol ) S.S.

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:

_________________ __________________

REPUBLIC OF THE PHILIPPINES )

City/Municipality of _____________ )
Province of Bohol ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in the __________________, Province of Bohol, personally
appeared:

Name Proof of Identity (ID) Place and Date of Issue

Known to me and to me known to be the same persons who executed the foregoing instrument and
acknowledged to me that the same are their free and voluntary deed.

This instrument, consisting of one (1) page, including the page on which this acknowledgment is written,
has been signed on the left margin of each and every page thereof by the concerned parties and their
witnesses, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL on this _________________ at _______________________,

Philippines.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.
REPUBLIC OF THE PHILIPPINES )
City/Municipality of _____________ )
Province of Bohol ) S.S.

PROMISSORY NOTE

FOR VALUE RECEIVED, I/We jointly and severally promise to pay without need of demand to
the order of __________________, at its office at __________________, Philippines, the sum
of PESOS: _______________________________ (P_______________), payable in
installment for a period of ___________________________ months at the rate of
___________________________________ (P_____________) per _____________,
starting on _____________ until fully and completely paid.

Time is declared of the essence hereof and in case of default in the payment of any installment
due, all the other instalments shall automatically become due and demandable together with all interest
that may have accrued and shall make me liable for the additional sum equivalent to
______________________ (____%) percent per month based on the total amount due and
demandable as penalty, compounded monthly until fully paid; and in case it becomes necessary to
collect this note through any Attorney-at-Law, the further sum of __________________ (____%)
percent thereof as and for attorney's fees, which shall not be less than
P_________________________ in any event, exclusive of costs and judicial/extra-judicial
expenses Moreover, I further empower the holder or any of his authorized representative(s), at his
option, to hold as security therefore any real or personal property which may be in my possession or
control by virtue of any other contract.

In case of extraordinary change in value of the peso due to extraordinary inflation or deflation
or any other reason, the basis of payment for this note shall be the value of the peso at the time the
obligation was incurred as provided in Article 1250 of the New Civil Code.

DEMAND AND NOTICE OF DISHONOR WAIVED. I hereby waive any diligence, presentment,
demand, protests or notice of non-payment or dishonor pertaining to this note, or any extension or
renewal therefore. Holder(s) may accept partial payment(s) and grant renewals or extensions of
payment reserving its/their rights against each and all indorsers, and all parties to this note. Acceptance
by holder(s) of any partial payment(s) after due date shall not be considered as extending the time for
payment or as a modification of any conditions hereof.

All actions arising from or connected with this note shall be brought exclusively in the proper
courts of Tagbilaran City, Philippines; and in case of judicial execution of this obligation or any part of
it, the debtor waives all rights under the provisions of Rule 39 Sec. 13, of the Rules of the Court.

_________________, ________________, Philippines.

___________________________
MAKER
REPUBLIC OF THE PHILIPPINES )
City/Municipality of _____________ )
Province of Bohol ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in the __________________, Province of Bohol, personally
appeared:

Name Proof of Identity (ID) Place and Date of Issue

Known to me and to me known to be the same persons who executed the foregoing instrument and
acknowledged to me that the same are their free and voluntary deed.

This instrument, consisting of two (2) pages, including the page on which this acknowledgment is
written, has been signed on the left margin of each and every page thereof by the concerned parties and
their witnesses, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL on this _________________ at _______________________,

Philippines.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.