Withdrawal Form 2016

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WITHDRAWAL SLIP

Date: _____________

Received from SRESLA the sum of: Php __________________

Amt. in words: __________________________________________

Withdrawn through: Transfer to Acct. Check

______________________________________________
PRINTED NAME over SIGNATURE
…………………………………………………………………….
AUTHORIZATION

I hereby authorize_____________________________________
to receive the proceeds of this withdrawal on my behalf.
Acct. No: __________________________

Depositor’s Signature: Recipient’s Signature:

________________________ _________________________

Signature Verified by/date:


……………………………………………………………………
APPROVED:

_______________________ ______________________
BOARD OF TRUSTEES BOARD OF TRUSTEES
…………………………………………………………………
For SRESLA use only:

DA No: _______________ Date: _______________


Check No: _____________ Date: _______________
DV No: _______________

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