I, X son of Shri…………….resident of …………….hereby acknowledge the receipt of Rs ………….. from Y son Shri. …………….……………resident of having borrowed from him today and I hereby promise on demand to pay the said sum of Rs…………. With interest at the rate of ……………. Per cent per annum with quarterly rests to the said Yor his successors and assigns.

Dated the ………….. day of ………. 20 ….

WITNESSES

1 .
2. ………………………….
X