MOVE-OUT FORM
NAME: CHARELLE DOMO MOBILE NO.: 09560372795
UNIT/BED: 16Q-1 PREFERRED MOVE-OUT DATE & TIME: June 12, 2020 8:00AM

A. SECURITY DEPOSIT REFUND ​(60 Working Days Processing)

OPTION 1: BANK DEPOSIT

*​There is a processing fee of P100.00. Please make sure that the bank details you will
provide are correct and accepts check deposit, otherwise, there will be a reprocessing fee
of P200.
BANK : BDO BPI ✓ METROBANK

ACCOUNT NAME : ANA RICA PANDAAN GARCIA

ACCOUNT NUMBER : 0849 2546 42
ACCOUNT TYPE : SAVINGS ✓ CHECKING

OPTION 2: CHECK FOR PICKUP

CHECK PAYABLE TO: ____________________________________________________________

(PRINTED NAME)

* Please make sure that the name you will provide is correct, otherwise, there will
be a reprocessing fee of P200.

AUTHORIZATION ​(To be filled out if Security Deposit Refund will be claimed by another person.)

I hereby authorize _______________________ to claim my Security Deposit Refund on my

behalf.

B. UTILITY ALLOCATION
For the purpose of utility allocation during the Enhanced Community Quarantine (ECQ), please
provide the dates you are present at Forbes Hall during ECQ period (March 17-May 31, 2020).

From: n/a To: n/a

CHARELLE DOMO
Signature over Printed Name