I, X son of 
……………   resident   of 
…………. confirm   that   I   
am  indebted  to Y son of ………….  Resident of 
………… to the extent of Rs. .................on    account 
of   the   price  
of   purchased   by  
me   from the said Y and I hereby
agree and covenant to pay the said sum on demand of Rs ………….. with
interest   at   the  
rate    of ………..  
percent per annum to Y. 
             
Date ……………                                                                                 signature
……………. 
                                                                                                                                          
X 
 
 
WITNESSES 
                            1. 
  
                                2.                                                                                  
  
 

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