20186843 BORDEREAU DE VERSEMENT/ DEPOSIT SLIP

SIEGE SOCIAL: PB: 11834 Yaounde

TEL: 222 23 30 68 - FAX: 222 22 17
RC 87R041/Cont. M10870000048E

No de compte/ Account Number

1 0 0 5

Intutule / Account’s Name: ………………………………………………………………………………………………………………………………………

Motif / Purpose : Depot en compte/ Deposit I-Card / Visa Prepaid AS / Flash Millenuim Flash Cash
Mobile Money Autres (preciser)………………………………………………

Billets / Notes pieces / Coins Origine des fonds/ Source of fun

Nb compare Montant/Amount Nb compare Montant/Amount Recettes d’exploration
500 Business Income
10 000
100 Emprunt / Loan
5 000
2 000 50 Salaire /Salary

1 000 25 Economies-Tontine
10 Private Saving
500
Total 1 Total 2 Autres / Other

Montant en chiffres / Amount in figures (1) + (2) FCFA

Montant en lettres / Amount in words: ………………………………………………………………………………….
……………………………………………………………………………………………………………………………
Nom, Tel.& signature de la partie versante / Name, Tel.& signature of depositor
Date …………………………………………
RESERVE A LA BANQUE / FOR BANK USE

Agence 00016 – FIRST BANK MBOPPI

00016 3005010101 -83
SEVEN ACADEMY
Guichetier SISS
BP 4450
HOTEL SERENE BALI BONANJO DOUALA
Gessionnaire YUOMBI TETU

Agence du client YUOMBI TETU

Motif NSAMA FAVOUR ANGEH

Piece identite N0: Delivere le: A:

Valuer Nombre: Montant

10 000 20 200 000

5 000 10 50 000

250.000 XAF

Client Chrochetier OPERTATION EFFECTUER

AVIS IMPORTANT: exiger une recu signe par l’argent du guichet / IMPORTANT NOTICE: Ask for receipt signed by the person at the
counter
Les operation nom consester dans un delais de 30 jour sont reputer conforme/ Unclaimed transaction after 30 days are conserved and can not be
subject