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Authorization Certificate Form
BOI authorization certificate form for special investors residence vista incentives
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: CERTIFICATION
This is to certify that I have authorized the person whose name appears below to
transact business with the BOI in my behalf pertaining to SIRV matters. Further, I am
aware that I have to immediately inform the BOI in case he/she is no longer authorized to
make transactions, and that failure on my part to comply with this requirement shall mean
that I shall be bound to acknowledge and be held accountable for any transaction which
he/she continues to make in my behalf with the BOI.
Issued this ____ day of ____________ 200__ at _______________________.
SIRV Holder
(Name and Signature)
SIRV No. _____________
Date Issued: _____________
Authorized Representative:
Name
Specimen Signature
Office/Agency
Address
Tel. No.
REPUBLIC OF THE PHILIPPINES
)
CITY/MUNICIPALITY OF __________) S.S.
SUBSCRIBED AND SWORN to before me this ___ day of ____________ 200__.
SIRV holder exhibited to me his/her Passport No. ____________ issued at
________________ on _______________.
______________________
NOTARY PUBLIC
Doc. No. ________
Page No. ________
Book No. ________
Series of 200___
