TMP-XT-18-20
APPLICATION FOR MC/ DD / SALE OF FCY
APPLICANT TYPE: Individual ✔ Corporate / Other Entity Reference No. (For Bank Use Only): _______________
Please fill out the page completely. Date of Application: _______________
CLIENT DETAILS
FULL NAME / ENTITY NAME REQUEST FOR
COMMUNITIES GENERAL SANTOS, INC. ✔ Manager’s Check Demand Draft Sale of FCY
ADDRESS: (No./ Building Name/Street/Barangay/City/Town/Province)
3L RIGHT WING CAMELLA FINANCE STARMALL ALABANG, MUNTINLUPA CITY
E-MAIL ADDRESS MOBILE NO. TELEPHONE / FAX NO.
lhi-annashley_ponsones@coho.com.ph 09282810621 3226-3552
APPLICATION FOR MANAGER’S CHECK / DEMAND DRAFT
PAYEE NAME (Last Name, First Name, Middle Name) PURPOSE
City Government of Las Piñas Business Permit
AMOUNT APPLIED FOR (in words) AMOUNT APPLIED FOR (in figures):
TEN THOUSAND FIVE HUNDRED PESOS ONLY 10,500.00
FOR DEMAND DRAFT ONLY MODE OF PAYMENT
CURRENCY IF DEBIT TO PESO ACCOUNT
Cash ✔
1002 7003 6792
Debit to Account No. _______________________
FX RATE AMOUNT IN PESO
USD Third Currency On- Us Check No. ___________________________________________
Pls. specify: ______________________ 0.00 D
REQUEST FOR SALE OF FCY D D
AMOUNT (in words): AMOUNT
D (in figures):
CURRENCY FX RATE AMOUNT IN PESO FX PROCEEDS
USD Third Currency Cash Credit to Account No. ______________________
Pls. specify: _________________ 0.00
OTHER INSTRUCTIONS
DEBIT AUTHORIZATION
The application is subject to the conditions below to which I/we agree. If payment is to be debited from a deposit account, this will authorize the Bank to debit my/our account for the
payment of the MC/ DD/FCY including Bank charges. Further, I/We declare under the penalties of perjury that my/our co-depositors is/are still living.
For Authorized Representative/s only:
This will authorize __________________________________________________________________ whose signature appears below, to acknowledge receipt of the above instrument. This will
further hold the Bank free and harmless from any liability whatsoever that may arise in the event of any loss or unauthorized negotiation of the instrument.
________________________________________________ ______________________ ____________________________________________________ ______________________
Client / Authorized Signatory DATE Authorized Representative DATE
(Signature Over Printed Name) (Signature Over Printed Name)
FOR BANK USE ONLY MC / DD / NOTES RECEIVED BY
PROCESSED AND SIGNATURE VERIFIED BY: APPROVED BY:
________________________________________ ___________ ________________________________________ ___________ __________________________________________ _____________
(Signature Over Printed Name) DATE (Signature Over Printed Name) DATE Client/Authorized Representative DATE
(Signature Over Printed Name)
TERMS AND CONDITIONS
CONDITIONS ON FUND TRANSFER / PAYMENT
Union Bank of the Philippines ("the Bank") will take the customary steps in the fund transfer / payment subject of this Application. The Bank is free to make
use of any correspondent, sub-agent or any other agency, but in no case shall the Bank or any of its correspondents be liable for mutilations, interruptions,
omissions, errors, non-transmission, or delays occurring in the mails, or on the part of any telegraph, cable, or wireless company, or any employee of such
company, or for any reason or cause whatsoever beyond the control of the Bank or its correspondents / agents.
The Bank may send any message relative to this fund transfer / payment in explicit language, codes or ciphers and shall not be liable for errors, neglects or
defaults of its correspondents, sub-agents, or other agency.
Any draft issued will be advised immediately to the drawee. The drawee will not be responsible should the draft be dishonored as a result of delay in
presentation or late arrival or non-arrival of advice of the drawing or for any other reason beyond the drawer's control.
The Client - Applicant assumes / accepts full responsibility for fraudulent or erroneous instructions provided that the Bank has complied with the terms and
conditions set forth in this application.
CONDITIONS ON ISSUANCE OF MANAGER'S CHECKS / DEMAND DRAFTS
If the Manager's Check (MC) or Demand Draft (DD) is lost, stolen, or destroyed, the Applicant shall provide the Bank with a bond indemnifying the Bank against
any and all liability whatsoever with respect to the lost, stolen, or destroyed MC / DD as a condition precedent for the replacement by the Bank of such lost,
stolen, or destroyed MC / DD issued by the Bank. MC's however, shall not be subject to Stop Payment in case of loss.
The Client assumes / accepts full responsibility for Manager's Checks issued in favor of Government Offices provided that the Bank has complied with all the
requirements in processing such a transaction.
The Client - Applicant shall also assume / accept full responsibility for fraudulent or erroneous instructions relative to the MC / DD issuance provided that the
Bank has complied with the terms and conditions set forth in this application.
