Date: DD MM YY

(DD – M M –Y Y)

HSBC Philippines

APPLICATION FORM FOR CASHIER’S ORDER/DEMAND DRAFT

Please tick where applicable:

Demand Draft (foreign currency) Cashier’s Order (Philippine Peso)

Name of Applicant:
Contact number of Applicant:
Name of Beneficiary:
Purpose of Cheque

Currency and Amount

Currency Amount excluding charges
Currency Amount including charges
Amount in words

In payment, please debit my/our Currency Account No.:

Authorize a representative to receive the Cashier’s Order/Demand Draft

I/We authorize to receive the requested Cashier’s Order/Demand Draft.
(name of authorized representative)

Signature of Applicant 1 Signature of Applicant 2 Signature of Applicant 3 Signature of Applicant 4

S.V. S.V. S.V. S.V.

Cashier’s Order/Demand Draft

RECEIVED

By: Date:

For Bank Use Only

CO/DD Cheque No.
Please tick if verified
E97 World Check (For Demand Draft Application only) SPECIAL INSTRUCTIONS/C42
E921 OPS 54/BOG 3

Checked by: Officer’s Signature

Issued by The Hongkong and Shanghai Banking Corporation Limited

Reference Number RBWM_22Jan2016_0276