Date :    
   
  To : The Branch Head  
  Landbank of the Philippines  
  _____DARAGA_____ Branch  
   
  Subject : Authority to Debit/Credit Account  
   
  Please debit ________________________ ______________________________________
(Account Number/Account Name)
 
  the amount of PESOS _______________________________________________________
 
  _____________________________________________________ (P _________________)
 
  and credit ________________________________________________________________
(Account Number/Account Name)
 
Representing:
  __________________________________________________________________
   
                 
                 
   
  This is to authorize you to debit my/our account for the corresponding service charge
 
 
For Joint Account: I/We declare under penalty perjury that my/our co-depositor/s is/are
  still living.
 
   
  CORAZON L. MARILLA CARLOS IRWIN G. BALDO, JR.
  (Name and Signature of Authorized Signatory) (Name and Signature of Authorized Signatory)