(Date) 3anco De Oro Unibank, Inc Awtention = | (ranch Head) Dear Sir/Madam: This serves as my/our authorization to Banco De Oro Unibank, Inc. Rackwell Branch to Issue a certificate of bank deposit) placement, with the following details: ‘Account Name \ecount Number E ‘Account N | ‘Addressee address _Dxte tobe Cenied Purpose (please specify: ‘Additional informations as applicable) liwe hereby waive my/our rights under existing aws related to the confidentiality of bank deposits and further unconditionally and irrevoeably hold free and harmless as well as indemnify Banco De Oro Unibank, Ine, its directors, officers, employees and representatives (collectively, the “Bank’) from any and all liabilities, claims, suits, charges or expenses of whatever nature arising out of or in connection with its issuance and my/our use of the ceruification Further, we authorize the Bank to dlsclase any/all information regarding the aforesaid benk deposit/placement in the event said institution to whom the certification is submitted seeks confirmation ofits contents Thank you. very truly yours, Printed name and signature of Depositor 1) (Printed name and signature of Depositor 2) ‘Note: (Printed name and slanature of all account holders tthe Joint or” account shal! be required ro sigaify the otter accoune ‘holaers' conformity to the issuance of the certification in favor of only one account holder)