I hereby acknowledgement that a sum of Rs………………………./-
(Rupees in word…………………………………………………………………………………………..)
Is due from me to Shri/ Mr/ Mrs/Miss…………………………………………………………………….
S/o……………………………………………………………………………………………………………
R/o……………………………………………………………………………………………………………
S/d……………………………………………………….
S/o. Shri…………………………………………………
Date:…………………. Address:………………………………………………..
…………………………………………………………..
…………………………………………………………..
