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“Withdrawal from the pension account of JOSEFINA QUIJANO AGUAS, my principal, who
entrusted to me his / her Automated Teller Machine (ATM) card”.
I also commit and guarantee that if something happened to said principal affecting the
authority given to me, I will immediately inform PVAO of the same and that failure on my part to
inform PVAO will constitute a violation of this Agency Agreement.
In this regard, I commit and undertake to indemnify any person who will be prejudiced or
damaged as a consequence of said withdrawal, in the amount equivalent to the total money
withdrawn plus reasonable interests and charges thereof.
IN WITNESS WHEREOF, I hereunto set my hand this ______ day of __________ 20 ____ in
______________________________.
__________________________ ___________________________
Signature over Printed Name Signature over Printed Name
Witness Witness