FOR OFFICIAL USE ONLY | FINANCE MANAGEMENT

FINANCIAL ASSISTANCE

RELEASE FORM

First name of Beneficiary

Last name

Total Amount Issued

Amount in words:

NAME ON CHECK IF NOT BENEFICIARY:

Check Number

Date

Particulars: I acknowledge receipt of this amount and that this amount is provided by the United Filipino Canadian Associations in British Columbia (UFCABC) as financial assistance to those affected by the Lapu Lapu Block Party Tragedy.

Consent: I hereby give my consent to UFCABC to release my name and/or photograph (s), as well as that of my authorized representative(s) if applicable, to the public in connection with the release of the check.

Authorization: I acknowledge receipt of the above financial assistance on behalf of the above noted beneficiary.

Date presented to and approved by the board:

CASE #

KEEP INFORMATION CONFIDENTIAL