Date: _______________

BDO UNIBANK, INC.

____________________ Branch

Gentlemen:

This authorizes the bearer hereof, Mr./Ms. _________________________ with resident address at
________________________ and contact number/s of ________________________, to request, claim,
receive, and acknowledge receipt of my replacement BDO ATM Debit Card for and on my behalf.
Attached with this authorization letter are the following supporting documents for your use:

 Copy of my (Accountholder) current government issued identification documents

 Original current government issued identification documents of my representative

Further, this authorizes BDO to release my BDO ATM Debit Card to my representative without incurring
any liability therefore. I fully understand that with this authorization, my representative may access and
transact my account using the card. I hereby irrevocably and unconditionally waive all of my rights, claims,
cause or causes of action that I, my heirs, assigns or representatives, may now or in future claim against
BDO, its owners, directors, officers, employees, agents and representatives (the “BDO Group”) arising
from or in connection with the release of said BDO ATM Debit Card to my representative.

Finally, I hereby irrevocably and unconditionally agree to hold the BDO Group free and harmless from and
against any and all suits, claims, actions or proceedings of whatever kind or nature that any person may
file, claim or institute against the BDO Group arising from or in connection with the release of my BDO
ATM Debit Card to my representative in accordance with this instruction; and forever indemnify and
compensate the BDO Group against any and all losses, damages, liabilities, costs and expenses including
without limiting the generality of the foregoing attorney’s fees and costs of suit that the BDO Group may
suffer or incur by reason hereof or thereof.

Hoping for your kind consideration.

Very truly yours,

Signature over Printed Name