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N (ATD) Request Form Region: The Chief of Office Finance Service, BJMP I, , a member of the BJMPSLAI presently assigned at , do hereby execute this authority to undertake the following: authorize the BJMP Finance Service to deduct from my payroll the amount of One Thousand Five Hundred Pesos ( 1,500.00) Philippine currency, beginning , 20 as my Capital Contribution to be credited.

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