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I am a plan holder of St. Peter Life with Policy No. L137095940 that had
already been fully paid.
NOLAND B. BENGAR
Assignor
CTC No. _______________
Issued on _____________
Issued at ______________
_____________________________ _____________________________
ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in the City of Cagayan de Oro, this
_____________________ personally appeared the above-named person, known o
me and to me known to be the same person who executed the foregoing
instrument and he acknowledged to me that the same is his own free and
voluntary act and deed.