PROXY FORM

KNOW ALL MEN BY THESE PRESENTS:

That I, the undersigned member of the Public Safety Savings and Loan
Association Inc. (PSSLAI), a Non-Stock and Non-Profit organization, do hereby
nominate, constitute and appoint PMGEN EMMANUEL LUIS D LICUP, Director,
Directorate for Comptrollership, as my true and lawful attorney-in-fact or PROXY
to represent me and vote on my behalf during the special meeting scheduled
on_____________________, specifically for the purpose of removing the Incumbent
Board of Trustees of PSSLAI except for Independent Trustees, election of new
Board of Trustees, and on any and all matters and things that may come up at the
said meeting and adjournment thereof, as fully to all intents and purposes as I might
or could do personally if present.
The power and authority hereby granted shall remain valid and effective
unless withdrawn/ revoked by the undersigned through a written notice delivered to
the Corporate Secretary before the date of the meeting or shall be deemed
suspended and inapplicable in case the undersigned personally attend the meeting.
IN WITNESS WHEREOF, the undersigned member has executed this Proxy
Form this ___ day of ___________, 2021 at
__________________________________.

___________________________________
Printed Name and Signature of the Member
PSSLAI Member No.______________

SIGNED IN THEPRESENCE OF:

___________________________ __________________________________

 SUBSCRIBED and sworn to before me, this ____ day of ________, 2021, by
____________________________ who exhibited to me his/her
_____________________________ issued at ___________________ on
______________, 2021 as proof of his/her identity.

                                                                                                      
Doc. No.___;
Page No.___;
Book No. ___;
Series of 2021.
REMINDERS:
 Three (3) ORIGINAL copies of duly accomplished Proxy Form
must be submitted.

 All information, except for the date of the special meeting, must be
provided.

 Only PNP personnel are required to accomplish the Proxy Form.

 The Proxy Form must be notarized. Coordinate with your

respective Legal Officer/s for the notarization of the Proxy Form.