WITHDRAWAL SLIP UWe hereby authorize. whose signature appears below to withdraw the amount indicated from my/our account. We declare under the penalty of perjury that my/our co-depositor(s) is/are still living 1 2. SIGNATURE OF DEPOSITOR(S) SIGNATURE OF REPRESENTATIVE Proceeds Received By: Teller's Validation ACCOUNT NAME ACCOUNT NUMBER PESO EURO Check one (1) applicable box below. Please use separate withdrawal slip for each type of currency. Others: LANDBANK DATE JPY US $ (in figures) Verified By BRANCH OF ACCOUNT (for interbranch withdrawal) Received from LAND BANK OF THE PHILIPPINES the sum of (in words) Approved By THIS WITHDRAWAL IS SUBJECT TO THE TERMS AND CONDITIONS COVERING THIS ACCOUNT REVISADOK TOWER JO​