To Receive Money - Receipt (Customer Copy)

Receiver Name: DASARI DHANALAKSHMI

MyWUSM Membership Program MTCN: 328-401-2407
Date & Time: 03-08-2019 07:34 PM IST
Address: OTHERS,OTHERS, KAPAVARAM, PALACOLE, AP, IN, My WU Number:
54250 Agent Details: VARSHINI COMMUNICATIONS
DOOR NO 2 78 MAIN ROAD, KOPAVARAM
My WU Points Earned: VILLAGE PALAKOL MANDAL

Total My WU Points:
ID Type: Aadhaar Card
Operator ID: 310
Subject to terms and conditions : For Further
ID number: 614775010162 details please visit our website Amount Sent: 13.30 Kuwaiti Dinar
www.westernunion.in/mywu or contact Originating country: Kuwait
ID Issue Date: ID Expiry Date: Western Union Call Center at 1800 102 7111
Exchange Rate: 225.6355566

Mobile: 9849705017 Landline: * Please do not register again if you have already Payout Amount: 3,000.00 Indian Rupee
registered, as a new number will then be provided
Payment Mode
PURPOSE OF TRANSACTION: Family Maintenance
1.Cash Amount:
OCCUPATION: Self employed business
2.Cheque Amount:
RELATIONSHIP TO SENDER: Friend Cheque Number:
Sender name: RATNAM RAJU GARIKIMUKKALA Send Country: Kuwait
3.Acct, Transfer Amount:
Message: Account Number:

If you choose to provide details of your landline/mobile phone and/or your e-mail in the optional entries above you also expressly consent to receipt of such commercial communications in the indicated medium (telephone /
SMS / MMS / e-mail), to being notified of transfer collection by SMS and agree that any charges imposed by the provider of such services are your sole responsibility.

Important notice: the terms and conditions on which the service is provided are available in the pre transaction form, at www.westernunion.com and at the agent location. You are advised to read these terms & conditions, especially those restricting liability and data
protection, before signing this form. Western Union and its agents also make money from currency exchange. Please see further information regarding currency exchange and legal restrictions that may delay the transaction set forth below. Protect yourself from
consumer fraud. Be careful when stranger asks you to send money. Do not divulge the details of this transfer to a third party.

CUSTOMER DECLARATION & SIGNATURES

I declare the following – By Signing this form, I also:
1. The remittance received is a personal remittance indicated above and is not trade related or for 1. Expressly consent to the transfer of my personal data entered above to WU Affiliates located in countries such as the
the purchase of property, investments or for credit to sender’s/remitter’s NRE/FCNR account or U.S. for the purpose of providing the money transfer service to me and Undertaking the additional data processing
donations/contributions to charitable organizations. activities specified in the Data Protection section of the terms and conditions. I have the right to withdraw my consent at
2. During this calendar year, I have not received more than 30 remittances under the Reserve Bank any time.
of India Money Transfer Service Scheme (including this transaction). 2. Expressly consent to the carrying out of profiling activities and marketing communications.
3. I am the beneficiary of this transaction. 3. Confirm that the information I have provided is correct and that I have read and accepted the terms and conditions of
4. I warrant that the information shared by me in this form is true and correct. the service
5. I explicitly consent to my sensitive personal information being used for the purposes described in
the enclosed terms and conditions.

Customer Signature Date: Agent Signature

This service is governed by the Government of India Money Transfer Service Scheme applicable to Indian nationals and foreign tourists. As per RBI guidelines, payments above Rs.50,000/-are to be made by CROSSED cheque, demand draft or direct credit to receivers account (a cancelled cheque will require to be provided to confirm
account beneficiary). On an exceptional basis, and subject to due diligence by Agents, this rule may be waived for foreigners with a valid TOURIST visa. In line with its internal risk control guidelines, Western Union or Agents may apply additional due diligence to confirm that transactions are for family maintenance purposes and to
validate other regulatory or internal policy requirements. Agent may issue a crossed cheque for a smaller amount in such instances. For support, consumers in India can call 1800 102 7111.

To Receive Money - Receipt (Agent Copy)

Receiver Name: DASARI DHANALAKSHMI
MyWUSM Membership Program MTCN: 328-401-2407
Date & Time: 03-08-2019 07:34 PM IST
Address: OTHERS,OTHERS, KAPAVARAM, PALACOLE, AP, IN, My WU Number:
54250 Agent Details: VARSHINI COMMUNICATIONS
DOOR NO 2 78 MAIN ROAD, KOPAVARAM
My WU Points Earned: VILLAGE PALAKOL MANDAL

ID Type: Aadhaar Card Total My WU Points:

Operator ID: 310
ID number: 614775010162 Subject to terms and conditions : For Further
details please visit our website Amount Sent: 13.30 Kuwaiti Dinar
www.westernunion.in/mywu or contact Originating country: Kuwait
ID Issue Date: ID Expiry Date: Western Union Call Center at 1800 102 7111 Exchange Rate: 225.6355566
Mobile: 9849705017 Landline:
* Please do not register again if you have already Payout Amount: 3,000.00 Indian Rupee
registered, as a new number will then be provided
Payment Mode
PURPOSE OF TRANSACTION: Family Maintenance
1.Cash Amount:
OCCUPATION: Self employed business
2.Cheque Amount:
RELATIONSHIP TO SENDER: Friend Cheque Number:
Sender name: RATNAM RAJU GARIKIMUKKALA Send Country: Kuwait 3.Acct, Transfer Amount:
Account Number:
Message:

If you choose to provide details of your landline/mobile phone and/or your e-mail in the optional entries above you also expressly consent to receipt of such commercial communications in the indicated medium (telephone /
SMS / MMS / e-mail), to being notified of transfer collection by SMS and agree that any charges imposed by the provider of such services are your sole responsibility.
Important notice: the terms and conditions on which the service is provided are available in the pre transaction form, at www.westernunion.com and at the agent location. You are advised to read these terms & conditions, especially those restricting liability and data
protection, before signing this form. Western Union and its agents also make money from currency exchange. Please see further information regarding currency exchange and legal restrictions that may delay the transaction set forth below. Protect yourself from
consumer fraud. Be careful when stranger asks you to send money. Do not divulge the details of this transfer to a third party.

CUSTOMER DECLARATION & SIGNATURES

I declare the following – By Signing this form, I also:
1. The remittance received is a personal remittance indicated above and is not trade related or for 1. Expressly consent to the transfer of my personal data entered above to WU Affiliates located in countries such as the
the purchase of property, investments or for credit to sender’s/remitter’s NRE/FCNR account or U.S. for the purpose of providing the money transfer service to me and Undertaking the additional data processing
donations/contributions to charitable organizations. activities specified in the Data Protection section of the terms and conditions. I have the right to withdraw my consent at
2. During this calendar year, I have not received more than 30 remittances under the Reserve Bank any time.
of India Money Transfer Service Scheme (including this transaction). 2. Expressly consent to the carrying out of profiling activities and marketing communications.
3. I am the beneficiary of this transaction. 3. Confirm that the information I have provided is correct and that I have read and accepted the terms and conditions of
4. I warrant that the information shared by me in this form is true and correct. the service
5. I explicitly consent to my sensitive personal information being used for the purposes described in
the enclosed terms and conditions.

Customer Signature Date: Agent Signature

This service is governed by the Government of India Money Transfer Service Scheme applicable to Indian nationals and foreign tourists. As per RBI guidelines, payments above Rs.50,000/-are to be made by CROSSED cheque, demand draft or direct credit to receivers account (a cancelled cheque will require to be provided to confirm
account beneficiary). On an exceptional basis, and subject to due diligence by Agents, this rule may be waived for foreigners with a valid TOURIST visa. In line with its internal risk control guidelines, Western Union or Agents may apply additional due diligence to confirm that transactions are for family maintenance purposes and to
validate other regulatory or internal policy requirements. Agent may issue a crossed cheque for a smaller amount in such instances. For support, consumers in India can call 1800 102 7111.