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ACKNOWLEDGEMENT OF DEBT
I, the undersigned,
……………………………………………………….
(Name of the Debtor – the one who will pay the debt)
……………………………………………………….
(identity number)
Address:

……………………………………
……………………………………
……………………………………
……………………………………

Employed at:

……………………………………
……………………………………
……………………………………
……………………………………

do hereby acknowledge that I am truly and lawfully indebted to
………………………………………………………
(the Creditor – the one who will receive the payments from the Debtor
in the sum of …………………………………………………………………………………
(insert amount in words and figures)
being for ………………………………………………………………………………………
………………………………………………………….(specify reason or cause of debt)
I hereby bind myself to pay the full amount of the said capital by not later than
………………………………………………………………(insert final date of repayment)
Interest will be charged should payment not be received on the due date.
SIGNED at …………………………….. on this ………… day of …………………. 200 .
AS WITNESSES:
1.

………………………………………..

2.

………………………………………..

………………………………………………….
DE