Letter of Appointment Form

(For Client Signature)

Date: 01/31/2022

To Whom It May Concern:

Letter of Appointment

Effective from January 31, 2022 onwards, We appoint Ms. Maricel Lantican to manage our/my insurance
requirements as indicated below:
Account/s for assignment/transfer
Specific Policy number/s:
1. 2512101002211 4. __________________
2. __________________ 5. __________________
3. __________________ 6. __________________
All existing accounts
All existing and prospective accounts
Other instructions: ______________________________________________
Reason for assignment/transfer:
Preferred intermediary is a relative/friend
Personal reasons
Others: _______________________________________________________

We/I authorize our insurer(s) to provide Ms. Lantican a quotation of fire insurance and/or its
representatives with all information they request regarding our/my insurances and claims history.

This appointment replaces any existing arrangement in place between us/me and any other insurance
intermediary formally appointed to advise on or arrange or negotiate our/my insurance requirements as
described above.

Thank you.

______________________
Client name

Name of Client
Mr. Ms. Mrs.
Last Name First Name Middle Initial(M.I.)

Mobile / Landline Morales Miguel Pocholo Nuguid

Email Address Asstnt.mikolascorp@gmail.com