CARD SME BANK INC.

UNIT: _______________________
CENTER WEEKLY COLLECTION

Center Name: SAN RAFAEL 5 A.O.: Time of Arrival: Date:

Name of Members Payment Signature Name of Members Payment Signature
1 Almaida, Julieta B. 41 Sanchez, Alberto U.
2 Ambita, Analyn C. 42 Sarmiento, Lauro F.
3 Austria, Erlinda R. 43 Sarmiento, Marcelina F.
4 Austria, Dominador D. 44 Sarmiento, Sally C.
5 Baybay, Marilyn S. 45 Tolentino, Catherine L.
6 Baybay, Marcelo E. 46 Tolentino, Felisa L.
7 Del Mundo, Mina F. 47 Tolentino, Loida M.
8 Del Mundo, Richard D. 48 Unico, Marilou D.
9 Españo, Cristina B. 49
10 Españo, Vicente M. 50
11 Españo, Veronica B. 51
12 Landicho Edna P. 52
13 Lanting, Cecille C. 53
14 Lanting, Marnily B. 54
15 Lanting, Marciana C. 55
16 Libang, Clarissa T. 56
17 Libang, Marvin G. 57
18 Librojo, Julia C. 58
19 Llanto, Emiliana M. 59
20 Lumbres, Antonio M. 60
21 Lumbres, Cleavon A. 61
22 Lumbres, Erlita A. 62
23 Lumbres, Magle P. 63
24 Lumbres, Sunshine A. 64
25 Maluping, Japonisa O. 65
26 Miral, Riza M. 66
27 Montablan, Marilou S. 67
28 Nedia, Fe P. 68
29 Oliva, Buena F. 69
30 Pacala, Ernesto O. 70
31 Pacala, Ma. Rosario G. 71
32 Pamplona, Lucilo P. 72
33 Pamplona, Marietta U. 73
34 Perez, Josephine U. 74
35 Platon, Apriliza L. 75
36 Platon, Loreta P. 76
37 Platon, Michael Denver L. 77
38 Platon, Loreta P. 78
39 Rosit, Melinda P. 79
40 Sanchez, Roberta U. 80
TOTAL COLLECTION ____________________ TOTAL COLLECTION ____________________

Cash Breakdown Amount in Words:

DOMINATION QTY AMT __________________________________________________
1000 __________________________________________________
500 __________________________________________________
200
100
Center Chief:
50
20 Secretary:
TOTAL
Remarks: Treasurer:
__________________________________________________
__________________________________________________ Remitted by:

O.R.: __________________________
Amortization: ___________________ Account Officer: