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AUTHORITY TO DEDUCT

DATE: ___________________

__________________________
__________________________
__________________________
AGENCY & ADDRESS

This serves as authority for you to effect the amount of exactly P ___________________ for _____ quarter/s from
my salary/ honorarium effective _________________________ until my loan from the RURAL BANK OF RIZAL
(K-A), INC. is fully paid.
This authority shall be enforced and effect until I revoke the same in writing duly acknowledged by the
lending institution.

CONFORME

_________________________________ _________________________________
Disbursing Officer Borrower’s Name and Signature

AUTHORITY TO DEDUCT

DATE: ___________________

__________________________
__________________________
__________________________
AGENCY & ADDRESS

This serves as authority for you to effect the amount of exactly P ___________________ for _____ quarter/s from
my salary/ honorarium effective _________________________ until my loan from the RURAL BANK OF RIZAL
(K-A), INC. is fully paid.
This authority shall be enforced and effect until I revoke the same in writing duly acknowledged by the
lending institution.

CONFORME

_________________________________ __________________________________
Disbursing Officer Borrower’s Name and Signature

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