SMetrobank ACCOUNT MAINTENANCE AND INSTRUCTION FORM Request for Automatic Transfer Arrangement (ATA) OD tag OD untag Oca O sa D1 others ‘Account Number. Reactivate Dormant Account Gea O sa OD otters, ‘Account Number (Closing of Account Oc Osa D_ otters ‘Account Number. Reason for Closing of Account . Replace the following Reason for Replacement DI Passbook C1 Certificate of Time Deposit D tostistoten OD otters. others. 1D Damaged Please accomplish the Affidavit of Loss of Card(s\/Passbook(s)/Check(s)/Certificate(s\/Confirmation at the back. “Resounthaldere Name and Signature a “scouniholders Name and Signature eM ORaOT S1 eane We, the undersigned depostor(syiustor(s). wih edéress at accordance with ian, depose and state that ‘ater being duly sworn in We have. doposa(s)funs(e) wih METROPOLITAN BANK & TRUST COMPANY (METROBANK") with accaunt namo _——____under ne flowing accounts}: 1 PesofFeraign Currency Deposit Accounts eso Deposit Accounts ‘Savings Account No. 1D cortiicate of Time ‘Current Account No. epost Account No. Foreign Currency Deposit Accouri (Ps. spely the curency af he account) ‘Savings Account No. (Cortese of Time ‘Current Account No. Deposit Account No. “The folowing documents) evidencing the aforesaid account's was/were loeUmisplacad/stlon and coud no longer be founaecovered despite dligent eters: 1 Pansbock No. 1 cactesk No. B cron. (We undertake io surrender the above-mentioned documents of the accounts) to METROBANK shoul Ibe found/recovered ‘The said deposi(s/funds)has/have not been assigned, negotiated, pladged cx cherwisecsposed or encumbered o ater personsenties, We are executing tis aida for the purpose of canceling the above documents and requesting METROBANK to issue a naw one We ae atowing the Bank to crcularize the deta ofthe lst document (s) oa its branches or to other banks asthe case may be, ofectate mylour request to ‘cancel the documents). ‘agree to Indernty and hold METROBANK, Its ofces and staff free and harmiess fom any sult acto, labity, loss andor damage that may sustain by ‘reason ofthe ess and cancalaion of he elorementoned decuments, inching the claims of thd parts who may have cbained sak leet documents or Intruments in good ath, INWITNESS WHEREOF, ie, have affind mylour signatures) at on ‘SIGHATURE OVER PRINTED NAME] ‘SIGNATURE OVER PRINTED NAMED DESIGNATIONPOSITION DESIGNATIONPOSITION Doe No Page No, Book No Series of