Republic of the Philippines)

_____________________________)

MADAM/SIR;

LETTER OF AUTHORIZATION

The undersigned, in my capacity as the owner expressly authorizing the bearer

_____________ to drive the car to wit;

MODEL : BODY TYPE:

MAKE : PLATE NO :
SERIAL CHASSIS : COLOR :
MOTOR NO :

That this authorization serves as tool in order that the bearer can able to transports using
the abovementioned vehicle all over the Philippines without legal impediment. That I do hereby
authorized the bearer to claim an insurance as the driver/passenger in my behalf any liability or
damage may occur either by accident or due fortuitous event that will the damage or
deterioration and what other result the case maybe.

This certification is Null and Void when the Vehicle uses in any illegal manner other than
what he is intend to used.

AFFIANT SAYETH NAUGHT:

______________________
Affiant

Contact No: _____

SUBSCRIBED AND SWORN to before me this _______ day of _____________ at

______________________________ Philippines.

Doc No.________
Page No._______
Book No._______
Series No.______