Philippine Coast Guard Savings and Loan Association, Inc, PCGSLAI Building, Coast Guard Base Furola, Farola Compound: Muelle dela Industria, Binondo, Manila, 1006 Manila Website: www pegslai.com,ph Tel, Nos.; (02) 243-7518 / (02) 243-7915 + Fax No.: (02) 708-9357 Cell. Nos.: 0917-5194259 (Globe) = 047-9949540 (Smart) WITHDRAWAL SLIP OD) capita CT savincs NAME {PRINT NAME} RECEIVED FROM THE PCG SAVINGS AND LOAN ASSOCIATION, INC. The sum of Pesos [P By Signing below, [ also, hereby agree to the PCGSLAI Privacy Notice and give consent to the Processing of my personal data pursuant to RA 10173 also known as the Data Privacy Act of 2012 SIGNATURE OF DEPOSITOR PRESENT ADDRESS / UNIT ASSL ENT AUTHORITY TO WITHDRAW ‘This authorizes whose (PRINT NAME) Signature appears below to-receive / withdraw the amount indicated above froe my / our account. SIGNATURE OF AUTHORIZED REPRESENTATIVE, SIGNATURE OF MEMBER - DEPOSITOR, ‘Verified by; Posted by: MUST BE SIGNED IN THE PRESENCE OF THE TELLER SIGNATURE OF RECIPIENT TELLER VALIDATION