Your First name/Last name

Address

Postal code/ CITY

Done in [your city], on [specify the date].

Subject: Acknowledgment of debt

I, the undersigned [indicate the borrower's full name], born on [indicate the borrower’s date of birth] in [indicate the borrower’s place of birth], residing at [indicate the borrower’s address], acknowledge owing [indicate the creditor’s full name], residing at [indicate the creditor’s address], the sum of [indicate the loan amount in figures AND in words], corresponding to the loan granted to me on this day.

I expressly undertake to repay this amount no later than [indicate the due date] at an annual interest rate of [indicate the interest rate, even if 0] from today until the date of payment.

[Your signature]