1/9/2020

SAN MIGUEL BREWERY INC.

A subsidiary of San Miguel Corporation

Region: Eastern Visayas Leyte Beer Region

Sales Office /District: District 2
Route No.: 6062A2
Customer Code 900260375

DEALERS DESIGNATION OF AUTHORITY

I. CUSTOMER PROFILE ( to be accomplished by the dealer):
Registered Business/Corporate/ Tel. No.:
Partnership Name: CALVIN'S STORE

Registered Business Address: Poblacion, Dagami, Leyte

Business Owner's Name (For Sole Prop): ROSALINDA E. DY Tel. No.:

Permanent Address: Poblacion, Dagami, Leyte Mobile No. 0917-3237143
Current Address:

I hereby authorize the hauling units enumerated below to withdraw stocks from San Miguel Brewery Inc. (SMB), and appoint and designate the persons
enumerated below as my/Corporation's/Partnership's representatives to sign and execute the documents specified herein on my/Corporation's/Partnership's behalf.
Any change in the said authorized hauling units and/or representatives shall be in writing and binding only upon receipt of a new Dealers Designation of Authority
by SMB.

Authorized Hauling units:

Plate Numbers
1. AAQ-7638 4. 7. 10.
2. RLR-922 5. 8. 11.
3. 6. 9. 12.

Authorized Representatives to sign any of the following:

Sales Order / Cash Receipt / Empties Return Order / Credit Memo /
Delivery Receipt / Sales Invoice / Withholding Tax Credit Memo / Shipping
Memo / Stock Transfer Receipt Specimen Signature

1.
ROLAND E. DY / OPERATIONS MANAGER
Name and Position

2.
ANTHONY E. DY / HR
Name and Position

3.
DUANE VINCENT C. DY / HAULER DRIVER
Name and Position

4.
CALVIN ANTHONY C. DY / FORKLIFT OPERTOR
Name and Position

5.
PETER JOHN DY NICOLAS / DRIVER HAULER
Name and Position

6.
EDWIN E. BORJA / DRIVER
Name and Position

7.
EVELYN A. BLONES / ENCODER/WIC
Name and Position

8.

Name and Position

Authorized Representatives to sign any of the following:

Statement of Account / Inventory Count Specimen Signature

1.
ROLAND E. DY / OPERATIONS MANAGER
Name and Position

2.
ANTHONY E. DY / HR
Name and Position

3.
EVELYN A. BLONES / ENCODER/WIC
Name and Position

I hereby confirm the accuracy and completeness of all the above information. I also confirm my authority to make the authorizations and
designations herein pursuant to the authority given me under Annex J of the existing Exclusive Dealership Agreement between
SMB and myself or the Corporation/Partnership I represent. The foregoing authorizations and designations supersede any previous
authorizations and designations made by me or the Corporation/Partnership I represent from the date of receipt hereof by SMB indicated below.

The information provided in this form, including any personal and sensitive information, is subject to the consent statement in the New
Dealer Application Form I signed and agreed to, and forms part of the Information as defined therein.

Business Owner / Authorized Representative Date

(Name & Signature)

II. RECEIPT BY SMB

Received by: Date:

(Signature over Printed Name)

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