Your First name/Last name

Address

Postal code/ CITY

Recipient

Address

Postal code/ City

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

Subject: Debt clearance receipt

Madam, Sir,

I, the undersigned [last name, first name], born on [date of birth] in [place of birth], residing at [indicate your address], acknowledge having received the sum of [amount in words] euros, i.e., [amount in figures] euros, paid by [payment method], from [last name, first name], born on [date of birth] in [place of birth] and residing at [indicate their address].

This amount corresponds to the loan I granted them on [date], now fully repaid.

This receipt therefore cancels the previous acknowledgment of debt established on [date] at [place of signature].

[date and signature]