Currency Date

Peso E uS Doltar Ll others

E Deposits Account Name
Use separate slip(s) for each type ol transaction.
,E current
Denomination
' f l Savinqs Account No. Pieces Amount
f l/fime Deoosit/
Placemeht
-
E Payor's Name Referenie No.

E Bills Payment Product Code

Subscriber's Name Subscriber's Account No.

E Cash Card Cardholder's Name/Contact No. Cash Card No.

Esale n Reload

E Payment Borrower's Name Promissory Note No. / Trade Reference No.

[] Loan I Trade
J
Machine Validation

Depo:it
Savings Acct, Cash PHp i0.cr00.(,f
008890082769 Cash In:10.000.00 t
]tqOHE CAPLO B ISPINO
548 IF CO Dep Ref Fee:
"
Reffl;
Dale: 10 Jui 20tB 10-07*13 15:54:58 211N 548 603 220 Total Amount I

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