This document is an acknowledgement receipt for a loan taken out by a borrower using property as collateral. It states that the borrower, authorized by Andres Garcia under a special power of attorney, is using and offering as collateral a property covered by Title No. T-16928 to an association for a loan of a specified amount in Philippine currency. It was signed by the borrower, association president and treasurer and notarized on a specified date in Tabuk, Kalinga, Philippines.

1. REPUBLIC OF THE PHILIPPINES )
PROVINCE OF KALINGA ) S.S.
MUNICIPALITY OF TABUK )
ACKNOWLEDGEMENT RECEIPT
I, _____________, of legal age, married to ___________________,
Filipino Citizen and a resident of ___________________, hereby authorized by
Andres Garcia under Special Power of Attorney executed by Atty.
_________________ Notary Public and entered in Doc. No: 483 , Page No. 97;
Book No. 6 ; Series of 2005 to use and offer as a collateral the property covered
by Transfer Certificate of Title No. T-16928 in the name of Andres Garcia
containing an area of Two Hundred Forty Five (245) Square Meters situated at
__________________(address) to __________________________________
Association Inc., with a loan in the amount of _____________________
Philippine Currency with a Monthly Interest of Five Percent (5%f) beginning for
the month of _____________(date) until the Principal amount will return from
the Association.
IN WITNESS WHEREOF, we hereunto set my hand this _______ day of
_____________, 2005 at Tabuk, Kalinga, Philippines.
BY ________________
__________________________ _________________________
(President) (Borrower)
____________________________
(Treasurer)
SIGNED IN THE PRESENCE OF:
_______________________________ _________________________
SUBSCRIBED AND SWORN TO before me this ________ day January, 2005 at
Bulanao, Tabuk, Kalinga.
DOC NO. _______
PAGE NO. ______
BOOK NO. ______
SERIES 2005