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Promissory Note Hospital

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christinemae3567
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3K views1 page

Promissory Note Hospital

Uploaded by

christinemae3567
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PROMISSORY NOTE

Date: ____________________
AMOUNT: __________________

I,__________________________,mother of ______________________
who was admitted last ______________________ and was given a temporary
discharge, with postal address at _____________________________, promise to pay to
the order of _____________________HOSPITAL with postal address at
______________________ the amount of ___________________________ payable
within two weeks, until fully and completely paid. .

In the event that the obligation covering this Promissory Note has been paid in
full this Promissory Note is therefore discharged and without any legal effect
whatsoever.

I HEREBY AFFIRM AND ACKNOWLEDGE THAT I HAVE CAREFULLY READ AND HAVE
UNDERSTOOD ALL THE FOREGOING STIPULATIONS.

In Witness whereof, I hereby affix my signature this ___________________ at


_____________________, Philippines.

__________________________
(NAME OF AFFIANT)

SUBSCRIBED AND SWORN TO before me, a notary public in and for


________________ this ___________________. The affiant, whom I identified through
the following competent evidence of identity ________________________________
personally signed the foregoing instrument before me and avowed under penalty of law
to the whole truth of the contents of said instrument.

Doc. No. ______; Notary Public


Page No. ______;
Book No. ______;
Series of 2024.

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