Authorization to Deduct

COA authorization to deduct from Retirement Gratuity/Terminal Leave

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In connection with my application for Retirement/Survivorship/Separation benefits, I
hereby authorize the Accounting Office, Planning, Finance and Management Sector (PFMS),
to deduct from my
Retirement Gratuity (RA 1616)
Terminal Leave, whatever
outstanding accounts I still have from the following offices/lending cooperatives:

Accounting Office, PFMS (COA BILL)

PWA

Procurement/Property Services, GSO

COA Multi-Purpose Cooperative

SLAGA

PhilGASEA

CREMC

_________________________________
Retiree/Claimant-Date
(Signature over Printed Name)