SIMPLE FORM OF ACKNOWLEDGMENT OF A DEBT

This is to acknowledge that a sum of Rs.___________ has been found due from me on the basis of an account settled between Sh. ___________ S/o Sh. ________________ R/o __________________ and myself. That I undertake to repay the same within ____ months. That I clearly acknowledge this debt which I owe to the said Sh. __________ Dated: ________ (Signed) ______________ Address: _____________