Geraldo M.

Mejillano
78 Mabini St.
Sariaya, Quezon Philippines 4322

October 21, 2015

OR Staff
De La Salle Lipa
J.P. Laurel National Highway
Lipa City, Batangas 4217 Philippines

To whom it may concern,

I, Geraldo M. Mejillano, hereby authorize Francesca Marie Lanto to release to De La

Salle Lipa, the following information from my personal student’s account. I authorize her
to secure a copy of my grades for the Clearance and Grade Issuance for 1st Semester of
A.Y. 2015 - 2016.

In the event of an emergency, the proxy has authorization to act on my behalf for this day,
October 21, 2015.

I need a representative to act on my behalf, because I’m out of town and may not be able
to reached for certain periods of time.

The proxy is not allowed to use the information that she got for any other purpose than
specified in the letter.
Sincerely,
Geraldo M. Mejillano