Authority To Deduct: ATD Version 1.2015-05

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AUTHORITY TO DEDUCT

Member _________________________________________ Date Applied __________________

Assignment _________________________________________

Reason ______________________________________________________________________________

I authorize Asiapro Multi-Purpose Cooperative to Details of Deduction:


deduct the amortization amount from my service fee
Total Amount _________________
based on the agreed terms. Any amount in excess
shall be deducted from my Coop Share Capital,
Terms _________________
Savings, Dividends & Patronage Refund, and all
Amount of
other benefits due me.
Amortization _________________

________________________________ Start Date _________________


Member’s signature over printed name End Date _________________

Approved by: ____________________


Date: ____________________ Received by: _________________________
Date: _________________________
ATD Version 1.2015-05

AUTHORITY TO DEDUCT
Member _________________________________________ Date Applied __________________

Assignment _________________________________________

Reason ______________________________________________________________________________

I authorize Asiapro Multi-Purpose Cooperative to Details of Deduction:


deduct the amortization amount from my service fee
Total Amount _________________
based on the agreed terms. Any amount in excess
shall be deducted from my Coop Share Capital,
Terms _________________
Savings, Dividends & Patronage Refund, and all
Amount of
other benefits due me.
Amortization _________________

________________________________ Start Date _________________


Member’s signature over printed name End Date _________________

Approved by: ____________________


Date: ____________________ Received by: _________________________
Date: _________________________
ATD Version 1.2015-05

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