Your First Name/Last Name

Address

Postal code/ CITY

Recipient

Address

Postal code/ City

Done at [your city], the [specify the date].

Subject : Debt clearance receipt

Dear Sir or Madam,

I, the undersigned [name, first name], born on [date of birth] at [place of birth], residing at [indicate your address] have received the sum of [sum in words] euros, i.e., [sum in numbers] euros, paid by [moyen de paiement], from [name, first name], born on [date of birth] at [place of birth] and residing at [indicate your address].

This amount corresponds to the loan I gave him on [date], repaid in full to date.

This receipt therefore cancels the previously established debt acknowledgment dated [date] at [place of signature].

[date and signature]