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Por medio de la presente autorizo e instruyo a la instituci n financiera, en representaci n m a y de mi patrimonio, a debitar mi cuenta por los montos pagados a los que yo no tuviera derecho. Tambi n acepto, en representaci n m a y de mi patrimonio, que tales montos ser n devueltos al Building Service 32BJ Pension Fund. Comprendo que el Building Service 32BJ Pension Fund no tiene obligaci n o responsabilidad legal por p rdidas debido a informaciones err neas o falsas que suministre y.

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