Date :
To : Metrobank- Camarin Rd. Caloocan Branch
Re : Authorization Letter to Pick-up Document(s)
I/We authorize the following to pick up and receive the document(s) described below on behalf of
__________ upon presentation of valid identification card(s) acceptable to the Bank:
Name of Authorized Representative/s
Specimen Signatures
Document(s): (except for documents that require SPA, Secretary’s Certificate, Partnership
Resolution and/or Undertaking)
1. ______________________
2. ______________________
3. ______________________
This authority shall be valid for two (2) years from date of receipt of the Bank. If there is any
change in my/our representative/s, I/we shall promptly submit a new Authorization Letter.
We hereby hold the Bank free and harmless from, and shall indemnify the Bank against, any
claim, damage or liabilities arising from any unauthorized disclosure committed by our
representative/s or any violation by such representatives of the confidentiality of the documents
received from the Bank.
_______________________________ ______________________________
(CLIENT/AUTHORIZED SIGNATORY) (CLIENT/AUTHORIZED SIGNATORY)
Date signed: ______________ Date signed: _____________
For Bank Use
Signature Verified by
__________________________________
Signature Over Printed Name of the BOO
Received by
__________________________________
Signature Over Printed Name of the BOO
Date of Receipt / Valid up to
____________ / ___________
MB-I-M-102-t/Rev. Mar.’11
