FREEZING REQUEST FORM

Please accomplish 2 forms – club’s copy and member’s copy.

I. MEMBER INFORMATION
Name: Date Requested:
Mobile No: Landline: E-mail:
Home Address:

II. TYPE OF FREEZING

Medical Travel Others
Attach proper documentation with this form. For reasons other than medical or travel, freezing is subject for approval. If others, please
specify:

III. DURATION OF FREEZING

Start Date: End Date: No. of Days:
Note: Freezing is one (1) month minimum and three (3) months maximum only.

III. STATE REASON BELOW

IV. FOR ADMIN OFFICE ONLY

Request approved? ( ) YES ( ) NO
Approved by (Club Manager): Date of Approval:

V. AUTHORIZATION
Member’s Signature: Received By (Admin Officer):