CERTIFICATE OF WITHDRAWAL WITHOUT RECOMMENDATION

TO ALL WHOM IT MAY CONCERN:

This is to certify that Bro. ............................................................... therefore a member of .............................................. Lodge No. ............................. F. & A. M., under the jurisdiction of the Grand Lodge of the Philippines, has paid his dues in full and has this day withdrawn from membership in Lodge.

Given at the Hall of our Lodge aforesaid, at ........................................... Philippines, this ............ Day of ..............................., 20.......... as witness my hand, the seal of our lodge, and the attestation of our Secretary.

.................................................... Master (Seal)

Attest: .................................................... Secretary