APPENDIX 10.4
AUTHORITY TO DISCLOSE INFORMATION
The undersigned, ____[name of foreign investor or duly authorized
representative of the foreign investor, pursuant to the sworn special authority (copy
attached) issued by the foreign investor]_______, hereby grants unto ____(name of
custodian bank)_____ the authority to disclose to the Bangko Sentral ng Pilipinas
(“BSP”) any information as may be required to comply with the post-audit requirements
for the registration of his investments in peso-denominated government securities
amounting to PHP______________ covered by Confirmation of Sale dated ________ by
__(name of accredited dealer)__, and/or peso time deposits with tenor of at least 90
days amounting to PHP______________ under Certificate of Time Deposit No. _______
with __(name of depository bank)____.
It is understood that the authority granted to __(name of custodian bank)_ does
not include the disclosure of any information on said investment/s to parties other than
the BSP.
This authority is being executed to facilitate the BSP registration of said
investment/s through _______(name of custodian bank)_____.
__________________
Date
_________________________
Signature over Printed Name