7 = SSIs Patten 4748 4451 0286 8268 005 WE 118 | a se 5107090012 | @LANDBANK Banciver ius “the Jiane= es SN “gy % ~WISA 4748 4451 0286 8268 005 B | WE 1128 oe oR ne 5107090012 ANDI &G S l GS Soenment Service Insurance System Teoun 8 Branch Office Osmena St., Tagum City Telephone Number: (084) 655-6168 CONFIRMATION SLIP Lauthorize the GSIS to deposit my unclaimed check to my GSIS UMID/ecard Land Bank of the Philippines (LBP) bank account number_ $0709 co 2 He. Regie Printed Name & Signature Date Signed: __o#~ 02-20 (Please attach Confirmation Slip and submit or e-mail it to GSIS Tagum with Photocopies of your 2 valid IDs and picture of your GSIS LBP ATM card) > Make sure that the total size of attachment in your email is below 2MB. CP NUMBER__©929- #s¢-osce