August 13, 2018

To whom it may concern,

I authorize Benigno Cadlaon to request for, process and receive my Member’s Date Record from your
good office. He is authorized to do on my behalf, the procedure necessary to obtain the said record. In
addition, he is authorized to fill up the Claim Signature Form and Claim Form 1.

For your information, my membership details are as follows:

Name:
Address:
ID Number:
Contact Number:
Member since:
Government Office
Etc.

Your assistance on this matter will be very helpful. Thank you very much.

Respectfully,

Atty. Arnulfo H. Pioquinto