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INTEGRATED BAR OF THE PHILIPPINES

QUEZON CITY CHAPTER


2nd Floor, Room 235 Hall of Justice Bldg.,
City Hall Compound, Quezon City

____________________
Date

The President
IBP Quezon City Chapter
Rm. 235 2nd Floor
Hall of Justice, Quezon City

THRU: THE CHAPTER SECRETARY

Dear Sir/Madam:

I would like to transfer my membership from IBP __________________ Chapter


to QUEZON CITY CHAPTER.

Upon approval hereof, kindly inform the undersigned with notice to my


present Chapter and the IBP National Office. I shall be willing to pay my dues
including all assessments that may be imposed upon me.

Thank you.

Very truly yours,


(PLEASE PRINT LEGIBLY)
___________________________
PRINT NAME AND SIGNATURE

Residence:_____________________________
_______________________________________
Tel No. : _____________________________

Office Address_________________________
_______________________________________
E-mail Address:________________________
Tel No.________________________________
Fax No.________________________________
Cellphone No.__________________________

Roll No.________________
Date of Birth_____________
School: _____________________

LATEST PAYMENT / LIFETIME (if applicable)


IBP O.R. NO.____________
DATE ISSUED:____________
CALENDAR YR.____________
Lifetime No.____________

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