AUTHORIZATION LETTER WITH DEED OF INDEMNITY

This is to authorize Mr/Mrs/Ms. ________________________________ whose

signature appears below to receive my ATM CARD with Account/Card
________________.
In consideratoin of the foregoing, i hereby hold Land Bank of the Philippines
(the “Bank”), its officrs and employees, free and harmless jfrom all claims and liabilities
that may arise from the release of the above-mentioned ATM Card to my
representative whose signature appears below and further bind myself to indemnify
the Bank, its officers and employees, for whatever damages or prejudice it/they may
suffer, includng costs and expenses, as a consequence of the release of the ATM Card
to my representative.

ACKNOWLEDGEMENT

Republic fo th Philippines
City/Municipality of ________________BEFORE ME, a Notary Public, in and or for
the __________________ on __________________ personally appeared:

Affiant:

__________________________________
Signature over Printed name
ID’s presented/No. ______________
Representative:

________________________________
Signature over Printed name
ID’s presented/No. ___________

SUBSCRIBED AND SWORN to before me this 22 day of July 2019, at Pandan,

Catanduanes.

ATTY. KARMINA A. MARIANO

Public Attorney II
Pursuant to R.A. 9406