DATE REQUESTED      
  TAXPAYER SERVICE SECTION   RDO43
  RDO 43 PASIG   EAST PASIG
  (PLEASE WRITE CLEARLY & LEGIBLY)    
    Surname:  
  TIN:     Name:  
Mid.
    Name:  
  Tin NO.  
  (LAST NAME) (FIRST NAME) (MIDDLE NAME)    
                  Please Claim Your  
  TIN ID CARD On:  
  COMPLETE HOME ADDRESS    
  DATE OF BIRTH:     Date Received:  
  DATE OF REGISTRATION:      
  VERIFIED BY:          
                       

To whom it may concern:

This is to authorize Mr. Godofredo Domingo to request my TIN identification card on my behalf.

________________________
Printed Name & Signature