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AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
E-mail Address:
Mobile No.:
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of __________________)
Said persons acknowledged under oath to me under penalty of law, that the whole contents of this
document are true and the same are their free and voluntary acts and deeds.