Authorization Letter - Sample

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April ___, 2021

I, MR. ROMY MOLIDO GALARPE, of legal age, Filipino, married and a resident of
Bagontaas, Valencia City, Bukidnon, do hereby depose and state:

1. That I am a member of the Social Security System with the following member
data:

Name: ROMY MOLIDO GALARPE


SS Number: 08-0724394-7
Birthday: January 7, 1960

2. That I authorize MR. DOMINIQUE LIM YAÑEZ, of legal age, Filipino, and a
resident of Bagontaas, Valencia City, Bukidnon, to transact on my behalf any
SSS-related transactions in the Social Security System premises or virtually,
whichever is required of me of the institution;

That I am executing this authorization to attest to the veracity of the foregoing


facts and to support my decision regarding the aforementioned matters;

IN WITNESS WHEREOF, we hereunto affix our signatures this ___ day of April
2021 at Valencia City, Bukidnon, Philippines.

Signed:

ROMY MOLIDO GALARPE


Authorizer

DOMINIQUE LIM YAÑEZ


Authorized

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