COL Financial Group, Inc.is a PSE Trading Participant and Member of SCCP and SIPF.

Date _______________________________

Accounting Department
COL FINANCIAL GROUP, INC.
2401B East Tower, Philippine Stock Exchange Centre, Exchange Road, Ortigas Center, Pasig City 1605 Philippines
Tel. No. 6-515-888 | Fax No. 634-6958 | Email: withdrawals@colfinancial.com
(Please print, fill out and sign this form then submit via fax or email to COLs Accounting Department)


REQUEST FOR WITHDRAWAL OF FUNDS*
(*Funds can be withdrawn from free cash balances or from the proceeds raised 3 working days after a stock sale)

I/We hereby request for the withdrawal of the amount specified hereunder from my/our account with
COL Financial:

Amount in figure: ____________________________________________________________________

Amount in words: ____________________________________________________________________

SPECIAL INSTRUCTIONS:

[ ] CHECK PICK UP (Check payments to be picked up from COL Financials Business Center)
[ ] Please uncross checks for Encashment

[ ] DEPOSIT TO BANK ACCOUNT: (For verification purposes only, please indicate below your declared bank
account with COL.)

Bank / Branch
(Ex. BPI Tektite)

Your Bank Account Name
(Ex. Juan Dela Cruz)

Your Bank Account Number
(Ex. 1234 5678 00))



_________________________________________ ___________________________________________
Primary Account Holder Signature over Printed Name Secondary Account Holder Signature over Printed Name

COL Account No. _____________ - ____________

ID Type and No. ___________________________ (*ID details needed for check pick up)

Note: Requests received after our 11:00 AM cut-off will be processed on the next clearing day.

AUTHORIZATION: WITHDRAWAL THROUGH REPRESENTATIVE

I/We hereby authorize my/our representative whose printed name and specimen signature appear below, to
receive the proceeds of this withdrawal in my/our behalf.

_________________________ ____________________________ ____________________________
Representatives Printed Name Representatives Specimen Signature Customers Signature
Note: Valid identification from both the customer and his representative is required when securing payment.