DATE

ADDRESS NG SUSULATAN

To Whom It May Concern:

Greetings!

I, CRISTY D. BARCELON, of legal age and presently residing/working in _____________ , hereby authorize my husband, DARWIN JASON R. BARCELON, to claim/get/withdraw my money amounting to __________________________ (P000.00) from your good office/bank in my behalf and presenting copies of my two (2) cards for identification purposes.

Thank you very much.

Respectfully yours,

SIGNATURE OVER PRINTED NAME