RURAL BANK OF MONTALBAN, INC.

DEPOSIT SLIP
Savings Account [ ] Current Account [ ] Date

Account Number

Account Name

Type of Deposit

Cash
Check
Total Deposits

Thumb Mark Deposited By

CASH BREAKDOWN
No. of Pieces Denominations Amount
P1000
500
200
100
50
20
10
5
1
Others

Total
 RURAL BANK OF MONTALBAN, INC.
SAVINGS ACCOUNT WITHDRAWAL SLIP
PLEASE PRESENT PASSBOOK WITH THIS SLIP, IF DEPOSITOR CANNOT MAKE WITHDRAWAL
PERSONALLY, PLEASE ACCOMPLISH THE AUTHORIZATION BELOW. Pay to the ord
DATE:
Savings Account No. Pesos
Account Name (Print)

Amount to be withdrawn in Pesos: P

CASH BREAKDOWN
No. of Pieces Denomination Amount
P 1000
500
200
100
50
20
10
5
COINS
TOTAL P
Payment Received by:
Recipient
I/We hereby declare under penalties perjury that my/our co-depositor(s) is/are still living.
ON DEPOSITOR'S BEHALF
This serves as your authorization to pay from my/our account to

(Print Name)
whose signature appears below, saame duly identified by me/us, the amount indicated above.

Signature of Authorized Representative

Signature of Depositor(s)

Signature Verified by: Approved by: Paid by:

Account No. Account Name Check No. R/T No.

Date
Pay to the order of P

Pesos

Rural Bank of Montalban, INC.

Montalban, Rizal