DATE :

CODE : MS
a.) DR – code for Doctors both relievers/retainers
b.) MS – code for ON CALL medical staffs e.g.medtechs nurses,
c.) Employee ID number - indicate your ID number if Aventus employee
d.) G – general (payment for commission, reimbursement, Intellicare employees, shuttle./laundry and other
services)

TO : CASH MANAGEMENT DEPARTMENT AVENTUS

MEDICAL CARE INC.

RE : AUTHORIZATION LETTER AND REQUEST TO DEPOSIT/CREDIT (ATDC)

Dear Gentlemen;

This is to authorize AVENTUS MEDICAL CARE INC. to RECEIVE and DEPOSIT/CREDIT my professional fee/salary in payment
for my services rendered to AVENTUS. This letter of authorization and advice is being executed for the reason
that________________________________________________________ (state the reason).

Details of my personal account are as follows:

1. BANK NAME/BRANCH :
2. ACCOUNT NAME :
3. ACCOUNT NUMBER :
4. ACCOUNT TYPE :
Attached herewith is photocopy of my valid ID (PRC/SSS/Driver’s License/Passport) and TIN for reference

For any further queries, kindly reach me through the following.

•EMAIL ADDRESS :
•TELEPHONE NUMBER :
•MOBILE NUMBER :

This will be deemed effective for (1) one year from the date of the form. In any case that the endorsed account becomes
dormant, locked or wished not to be used anymore, please inform us immediately.

Thank you.

Truly yours,

Signature over Printed Name

IMPORTANT NOTE:

1. Fill out the needed information properly and accurately.

2. Provide photocopy of valid ids (PRC/SSS/Driver’s License/Passport)
3. Attach any proof of TIN reference
4. Email/Submit COMPLETE requirements to AVENTUS MEDICAL CARE INC Cash Management
Department (cashmanagement@aventusmedical.com.ph) and CC Accounting Department if
TIN ID/ proof of TIN is provided (accounting@aventusmedical.com.ph)
5. Cash Managament will only accommodate depositing/crediting to savings/current account thru the accounts
included in the attached list of banks. (Cashcard is not accepted)