(To be ac

REQUEST FOR AUTHORITY TO OPEN ACCOUNT

1 Name of Agency/Bureau/Office SAN VICENTE E/S - POZORRUBIO

2 Type of Bank Account

MDS SAVINGS ACCOUNT

∕ CURRENT ACCOUNT OTHERS____________________

3 Legal Basis and Purpose of Opening the Account
(State pertinent section/provision)
R.A. __________________
∕ Others JC 2019 - 1 COA - DBM
E.O. __________________ (e.g. MOA, Department Order/Circul
4 Funding Source
∕ R.A. __________________(GAA)
Other ____________________
GRANT _________________

5 Authorized Signatory/Signatories

1 JUAN DELA CRUZ 2 __________________________________

6 Bank Branch where the Agency/Buureau/Office intends to open an account
LBP BINALONAN

7 SIGNATURE OVER PRINTED NAAME OF AUTHORIZED OFFICER

JUAN DELA CRUZ

Do not fill-up this portion (For Bureau of the Treasury use only)
8

APPLICATION REF. NO.: _________________________________________________________________

EVALUATED BY: _________________________________________________________________

APPROVED/DISAPPROVED BY: _________________________________________________________________

(Signature over printed name of the Regional Director)

Reason for disapproval: _________________________________________________________________

Do not fill-up this portion (For the Bank use only)

9

This is to confirm the existence of Account Name ________________________________

Name of Agency
with Account Number _____________________ in Branch__________________________.

Signature over printed name of the Authorized Bank Officer

 Annex D-2

BTr FORM 1
(To be accomplished in quadruplicate)

OUNT

______________

2019 - 1 COA - DBM - DEPED

artment Order/Circular) Please attach copy

____________________
________________

__________________________________

only)

_____________

_____________

_____________

_____________
cer