X, son of __________ resident of _______________ confirm that I am indebted to
Y son of __________ resident of __________________ to the extent of Rs.
_________ ( Rupees __________________________ ) 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.