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REMITTANCE

Services: ⃣ Cebuana ⃣ Western Union ⃣ Smartmoney ⃣ Credit To Bank (CTB)


⃣ Ecash Padala ⃣ Ecash to Ecash

Date: __________ Time: ________

⃣ Sender ⃣ Receiver ⃣ Sender ⃣ Receiver

Name: _______________________________ Name: ______________________________


Address: ______________________________ Address: ____________________________
Mobile #: _____________________________ Mobile #: ____________________________
Email: ________________________________ Email: ______________________________
Amount: ______________________________
Occupation: ___________________________
Relationship to Receiver: _________________ Reference No. (For Payout only):
Source of Fund: ________________________
Country: ______________________________ ___________________________
ID Type & Expiration: ____________________
ID Number: ____________________________
Purpose of Transaction: __________________

Signature: ____________________________

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REMITTANCE
Services: ⃣ Cebuana ⃣ Western Union ⃣ Smartmoney ⃣ Credit To Bank (CTB)
⃣ Ecash Padala ⃣ Ecash to Ecash

Date: __________ Time: ________

⃣ Sender ⃣ Receiver ⃣ Sender ⃣ Receiver

Name: _______________________________ Name: ______________________________


Address: ______________________________ Address: ____________________________
Mobile #: _____________________________ Mobile #: ____________________________
Email: ________________________________ Email: ______________________________
Amount: ______________________________
Occupation: ___________________________
Relationship to Receiver: _________________ Reference No. (For Payout only):
Source of Fund: ________________________
Country: ______________________________ ___________________________
ID Type & Expiration: ____________________
ID Number: ____________________________
Purpose of Transaction: __________________

Signature: ______________________________

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