FIRST ISABELA COOPERATIVE BANK SANTIAGO CITY BRANCH

This is acknowledged receipt of Jewelry(ies) in the same condition as pledged and redeemed.

Date Received Signature of Borrower over Printed Name

AUTHORIZATION ____________
Date
I hereby authorized Mr/Mrs. _ _, whose specimen
signature appears below, to redeem my pledged jewelry(ies) coverd by PN/Application No. _______________

Specimen Signature Signature of Borrower over Printed Name

_____________________ _______________________________
Signature verified by Approved by

Date Received Signature over printed name of Authorized Representative

CERTIFICATION
We hereby certify that the borrower/authorized representative received in the same
condition of the pledged jewelry( ies).
LOIDA G. ACOSTA
Teller/Appraiser Authorized Officer

FIRST ISABELA COOPERATIVE BANK SANTIAGO CITY BRANCH

This is acknowledged receipt of Jewelry(ies) in the same condition as pledged and redeemed.

Date Received Signature of Borrower over Printed Name

AUTHORIZATION ____________
Date
I hereby authorized Mr/Mrs. _ _, whose specimen
signature appears below, to redeem my pledged jewelry(ies) coverd by PN/Application No. _______________

Specimen Signature Signature of Borrower over Printed Name

_____________________ _______________________________
Signature verified by Approved by

Date Received Signature over printed name of Authorized Representative

CERTIFICATION
We hereby certify that the borrower/authorized representative received in the same
condition of the pledged jewelry( ies).
0 LOIDA G. ACOSTA
Teller/Appraiser Authorized Officer