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    SDFGSDF 23 Q 4 SDFGDSF

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    Adventist Hospital Davao
    The document is a promissory note for Marygold Dela Peña to pay Davao Adventist Hospital, Inc. P4,776.60 for the hospital expenses of Petronilo Dela Peña from May 4-5, 2019 as an outpatient. Marygold agrees to pay the full amount by May 8, 2019 and will be charged a 500 peso late fee per month if payment is not made on time. The note details the terms of payment, options for prepayment, and actions that can be taken in the event of nonpayment including legal fees.

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    SDFGSDF 23 Q 4 SDFGDSF

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    Adventist Hospital Davao
    376 views1 page
    The document is a promissory note for Marygold Dela Peña to pay Davao Adventist Hospital, Inc. P4,776.60 for the hospital expenses of Petronilo Dela Peña from May 4-5, 2019 as an outpatient. Marygold agrees to pay the full amount by May 8, 2019 and will be charged a 500 peso late fee per month if payment is not made on time. The note details the terms of payment, options for prepayment, and actions that can be taken in the event of nonpayment including legal fees.

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    The document is a promissory note for Marygold Dela Peña to pay Davao Adventist Hospital, Inc. P4,776.60 for the hospital expenses of Petronilo Dela Peña from May 4-5, 2019 as an outpatient. Marygold agrees to pay the full amount by May 8, 2019 and will be charged a 500 peso late fee per month if payment is not made on time. The note details the terms of payment, options for prepayment, and actions that can be taken in the event of nonpayment including legal fees.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    376 views1 page

    SDFGSDF 23 Q 4 SDFGDSF

    Uploaded by

    Adventist Hospital Davao
    The document is a promissory note for Marygold Dela Peña to pay Davao Adventist Hospital, Inc. P4,776.60 for the hospital expenses of Petronilo Dela Peña from May 4-5, 2019 as an outpatient. Marygold agrees to pay the full amount by May 8, 2019 and will be charged a 500 peso late fee per month if payment is not made on time. The note details the terms of payment, options for prepayment, and actions that can be taken in the event of nonpayment including legal fees.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    ADVENTIST HOSPITAL- DAVAO, INC.

    “A Center for Total Health Care”


    Mailing Address: Km. 7 McArthur Highway, 8023 Bangkal, Davao City, Phils. E-mail address: [email protected] Tel. (082) 297 2597, Fax: (082) 298
    1692

    PROMISSORY NOTE
    FM-BOD-022 Rev. 2 as of January 1, 2014

    Principal amount: P4,776.60 DATE: 05/04/2019

    For Patient DELA PEÑA, PETRONILO confined in this Hospital as OUT PATIENT on 05/04/2019
    to 5/04/2019. I, MARYGOLD DELA PEÑA legal age resident of BLOCK 26 LOT 15 GULFVIEW
    SUB. BAGO APLAYA DAVAO CITY promise to pay Davao Adventist Hospital, Inc. the sum of
    FOUR THOUSAND SEVEN HUNDRED SEVENTY SIX 60/100) only Philippines Currency
    (P4,776.60) and interest at the yearly rate of 18% on the unpaid balance as specified below.

    I, MARYGOLD DELA PEÑA will pay one lump payment in lawful of my debt to the Hospital on:
    05/08/2019.

    If the affiant fails to make an installment payment when due or fails to comply with any other term of
    this promissory note, then it will be considered in default. A late penalty charge of 500.00 PhP per
    month will be assessed until the account is brought current inclusive of the late charges, interest and
    applicable fees.

    Affiant agrees that until the principal and interest owed under this promissory note are paid in full, this
    note will be secured by the ______________________________________________________
    (describe property, such as a car or a house.) Payments will be applied first to interest and then to
    principal.

    This note may be prepaid by the Affiant at any time in whole or in part without premium or penalty. In
    the event of the Affiant's death, the unpaid indebtedness remaining on the note shall be continued to
    the alive spouse or close relatives.

    The affiant must promptly inform the Hospital of any change in name or address.

    If the Hospital prevails in a lawsuit to collect on this note, affiant will pay Hospital's court costs,
    collection agency costs, and attorney's fees in an amount the court finds to be reasonable.

    IN WITNESS WHEREOF, I set my hand under seal this 4TH day of MAY, 2019 and I acknowledge
    receipt of a completed copy of this instrument.

    MARYGOLD DELA PEÑA


    Co-Maker Affiant’s Signature
    Valid ID Number: Valid ID Number:
    Contact Number: Contact Number: 09213017345

    Hospital Representative: DAPHNE R. PERONA


    Valid Identification Number:
    Contact Number:09099666579

    SUBCRIBED AND SWORN to before me this ______ day of ___ __, ____ ___ at Davao City,
    Philippines.

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