SAMPLE SLIP – SENDING / ENCASHMENT

[company SMART MONEY

name/logo]
TRANSACTION SLIP
 CUSTOMER INFORMATION
First Name Middle Initial Last Name

Present Address
Permanent Address same as present address
Contact Number (Landline / Celfone / Work)
Date of Birth
Place of Birth
Nationality
Civil Status
Nature of Work
Name of Employer
Business/Office Address
Type of ID Presented
SSS / TIN / Driver’s License / Others____
ID Number____
Source of Funds [ ] employment [ ] business [ ] allotment [ ] others. Please specify___________
TRANSACTION REQUEST DETAILS
Type of Transaction Amount(Php)
Cash Loading / Sending Encashment
Smart Money Account Number Smart Money Account Number
____-____-____-____ ____-____-____-____

Signature
Date
For Branch Authorized Personnel Use Only
Cashier Name & Signature
Date
Time
Transaction Reference Number