RECEIPT FOR DUES

Lodge No. …………………………… F. & A. M. Under the Jurisdiction of the Grand Lodge of F. & A. M. of the Philippines.

No. ………………………………… Date …………………………, 20……………

THIS IS TO CERTIFY THAT

Brother …………………………………………………………………………………………………………………………………………………… has paid dues from ………………………………………………, 20……… to………………………………………………………………………………, 20……… P…………………………………………………………………

………………………………………………………………… Secretary

M. W. GRAND LODGE OF F. & A. M. OF THE PHILIPPINES

This is to certify that the Lodge named on the reverse of this Certificate is a regular and legally constituted Lodge under the jurisdiction of the Grand Lodge, and that this is the only form of record for dues authorized by our Grand Lodge.

………………………………………………………………… Secretary