SURVIVORSHIP AGREEMENT

We, the undersigned, hereby agree with each other and with [Insert name of the bank]
(“Bank”), in relation to [Insert Account No.] (“Account”), as follows:

1. All moneys nor or hereafter contributed or invested by us or either/any of us to the

Account shall be deposited in and received by the Bank with the understanding and upon the
condition that said money be deposited without to their previous ownership. Said moneys, and all
earnings thereof or interest thereon, if any, shall be our joint property and shall be payable to,
collectible and withdrawable by either/any of us during our joint lives and upon the death of one
shall belong to and be collectible by the survivor/s.

2. The Bank has the full authority to recognize the signatures of any of us in the
payment, delivery or disbursement of funds or in the transaction of other business on the Accounts,
including termination thereof.

3. Upon the death of one of us, receipt of the survivor (or any of the survivors) of the
proceeds of the Accounts shall validly discharge the Bank as to all matters regarding the Accounts.

4. Any of us may contribute and endorse for inclusion in the Accounts, checks, drafts,
bills of exchange and/or other instruments for the payment of money payable or purporting to
belong to any one of us.

5. We hereby hold the Bank free and harmless from, and undertake to indemnify the
same against, any and all liabilities, losses, claims, damages and expenses it may incur as a result
of its faithful compliance with this agreement.

6. This is a joint and several agreement and is binding upon each of us, our heirs,
executors, administrators and assigns.

7. No change or modification of this agreement shall be effective unless in writing

and signed by both/all of us and by the Bank.

IN WITNESS WHEREOF, the Parties have hereunto set their hands this
____________________ in ____________________________.

Signature over Printed Name of Signature over Printed Name of

Principal/Depositor Principal/Depositor

Agreed: For and in behalf of [Insert Name of Bank]

Signature over Printed Name/Position of Signature over Printed Name of Branch

Branch Personnel Officer

Signed in the presence of:

______________________________ ______________________________
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF _______________________) S.S.

BEFORE ME, this ___ of day of ___________________, at

_______________________, Philippines, personally appeared before me the following persons,
and exhibited to me the following competent of their identities.

COMPETENT EVIDENCE OF
NAME
IDENTITY

known to me and to me known to be the same persons who executed the foregoing instrument
denominated as a SURVIVORSHIP AGREEMENT, consisting of two (2) pages, including this
page on which this acknowledgment is written, has been signed by the parties and their witnesses,
and acknowledged to me that the same is their own free voluntary act and deed.

WITNESS MY HAND AND SEAL, this ____ day of _____________________, at

__________________________, Philippines.

NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2018.