Name of the bank: _________________________

________________________________________ ___ /___________ 20__

Details of the Bank: _______________________
________________________________________

Subject:
We confirm that we have not received and not found the following transactions:

ARN (Acquirer's Reference Number): ___________________, __________________________

_______________________, _______________________, _____________________________
_________________________, _________________________, _________________________
RRN (Retrieval Reference Number): _________________________, ______________________
_____________________________, _________________________, ______________________
__________________________, _________________________, _________________________
Batch id: _________________________, ________________________, ___________________
__________________________, _________________________, _________________________
_________________________, ________________________, ___________________________

The account information is as bellow:

Card number: XX XXXX

Clients full name: _____________________________

This document is provided on customer request for futher tracing of his funds which are not
credited or founded.

_____________________
(signature/seal of the bank)