debt acknowledgement template

Below is a template for debt acknowledgment, you can use this for documenting the debts of people who owe you money.


I, [Debtor] the undersigned, born [birth date], of legal age, residing at [address], who is married to [name of spouse if any, omit if not applicable], and [son/daughter] of [name of parents], hereby confirm and acknowledge to the following creditor [name of creditor] that I am indebted to said Creditor, in the amount of [amount in words and numerals] as of the below mentioned date. The indebted amount were incurred from [reason of debt and date of occurrence]

I furthermore acknowledge that I have no argument with said debts which were incurred by myself, and for which I am solely responsible. This also means that I acknowledge that there are no defenses should said creditor decide to use this document in a court of law as a confession to judgment – where legally permissible.

I have agreed to pay off the entire amount indebted by [date].  [Optional: If I cannot pay the entire amount, I will negotiate a payment plan with Creditor within 15 calendar days from date below.]  I understand that failure to comply with the above condition shall be grounds for Creditor to take necessary lawful action.  I understand that this document may be tendered in legal proceedings as evidence.

Signed on this [  ] day, of the month [  ], in the year [  ].

[Debtor’s Name and Signature]

[Creditor’s Name and Signature]

[Witness name and Signature]

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