CHATTEL MORTGAGE

KNOW ALL MEN BY THESE PRESENTS:

WE, _____________________, Filipino citizens, of legal age, single/married to

____________________, with residence at ________________ hereinafter known s the
MORTGAGOR, and _____________________, Filipino citizen, of legal age, single/married
to ___________________, with residence at ______________________ hereinafter known
as the MORTGAGEE,

WITNESSETH:

That the MORTGAGOR is indebted unto the MORTGAGEE in the sum of

__________________ (Php______________), Philippine currency, receipt of which is
acknowledged by the MORTGAGOR upon the signing of this instrument, payable within a
period of _______________________ years, with interest thereon at the rate of
_________________ (_____________) per centum, per annum;

That for, and consideration of, this indebtedness, and to assure the performance of
said obligation to pay, the MORTGAGOR hereby conveys by way of CHATTEL
MORTGAGE unto the MORTGAGEE, his heirs and assigns, the following personality now
in the possession of said MORTGAGOR:

(Description)

That the condition of this obligation is that should the MORTGAGOR perform the
obligation to pay the hereinabove-cited indebtedness of ________________, together with
accrued interest thereon, this chattel mortgage shall at once become null and void and of no
effect whatsoever, otherwise, it shall remain in full force and effect.

IN WITNESS WHEREOF, the parties have hereunto set their hands, this ____ day
of ___________ at ________________, Philippines.

___________________ _____________________
Mortgagor Mortgagee

SIGNED IN THE PRESENCE OF:

___________________ ___________________

REPUBLIC OF THE PHILIPPINES )

CITY OF OLONGAPO )S.S.

I, Notary Public for and in the city/ municipality ___________________, do hereby

certify that _______________________ with CTC No. __________ issued at
_______________ on _________________, with Tax Account No. _________________ ,
personally known to me and to me known to be the same persons who executed the
foregoing instrument which they signed and acknowledged before me as their free and
voluntary act and deed.
.
-2-

The foregoing instrument relates to a CHATTEL MORTGAGE consists of two (2)

pages including the page on which this acknowledgment is written and has been signed at
the bottom and on the lefthand margin of the first page thereof, by the ____________ and
his instrumental witnesses, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL.

Doc. No: ______; FEDERICO T. MACABANGUN

Page No: ______; Notary Public
Book No. I ; Until December 31, 2009
Series of 2009. PTR: 4502255, 01-14-09, O.C.
IBP: 764481, 1-09-09, O.C.
ROLL No. 19845

AFFIDAVIT OF GOOD FAITH

WE, the undersigned MORTGAGOR and MORTGAGEE hereby jointly and

severally swear that we executed the foregoing Chattel Mortgage in order to secure the
indebtedness therein specified and for no other purpose or purposes contrary to law.

_______________________ _______________________
Mortgagor Mortgagee

REPUBLIC OF THE PHILIPPINES )

CITY OF OLONGAPO )S.S.

SUBSCRIBED AND SWORN to before me this ______ day of ________________

at Olongapo City, personally appeared _________________, with CTC NO. ___________
issued on ______________ issued at _________________, known to me to be the same
person who executed the foregoing instrument and acknowledged to me that the same is
her/her free act and voluntary deed.

WITNESS MY HAND AND SEAL.

Doc. No: ______; FEDERICO T. MACABANGUN

Page No: ______; Notary Public
Book No. I ; Until December 31, 2009
Series of 2009. PTR: 4502255, 01-14-09, O.C.
IBP: 764481, 1-09-09, O.C.
ROLL No. 19845