DATE

_______________
_______________
_______________

RE : Notice of Returned Check with Demand

to settle outstanding obligation

Dear __________:

We write for and in behalf our client, ______________________., in connection with the
above-mentioned matter.

Based on records endorsed to us by our client, it appears that you issued a check drawn
with ________with check No. ___________________in the amount of ________________as
payment for monthly amortization. Upon presentment for payment, however, the said check was
dishonored and subsequently returned by the bank due to “DAIF”.

To date, however, despite repeated demands from our client, you failed, refused and/or
neglected to make good or replace said checks and/or pay to pay with cash.

We hope for your preferential attention on this matter.

Thank you.

Very truly yours,

___________