Sample Check Deposit Slip Withdrawal Slip

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CV₽ No.

Account Account Name CHECK No. BRSTN


123-45-678910-1 xxxxxxxxxxxxx 0000123456
DATE ___________________
PAY TO THE
ORDER OF ____________________________________________________ ₽
PESOS ____________________________________________________________________________________
I / We allow the electronic clearing of this check and hereby waive the presentation for payment of this original to ABC Bank

123 - 45 – 678910 – 1
ABC Bank
GANA CENTRO BRANCH
GROUND FLOOR, GANA CITY ________________________________

*003030393930303939303030303939*****0000020201010101010101010101020202020*******020202010101010101010101010

*****0000020201010101010101010101020202020*******

ABC Bank
PLEASE LIST ON THE DETAILS COLUMN, IF CASH DEPOSIT, ITS DENOMINATION AND
DEPOSIT SLIP NUMBER OF PIECES, AND IF CHECK DEPOSIT, THE CHECK DETAILS.

THIS DEPOSIT IS GOVERNED BY CONDITIONS IN THE DEPOSIT ACCOUNT AGREEMENT DETAILS


IF CASH-DENOM NUMBER OF PIECES/
IF CHECK-DRAWEE CHECK NUMBER
CURRENCY TYPE OF ACCOUNT DATE AMOUNT
BANK-BRANCH

C PHP USD
SAVINGS
CHECKING
OTHERS ______
OTHERS
TYPE OF DEPOSIT (PLEASE SEPARATE SLIPS FOR CASH AND CHECK DEPOSITS)

CASH ON-US CHECK LOCAL CHECK

REGIONAL CHECK MANAGERS CHECK OTHERS _______________

ACCOUNT NUMBER

ACCOUNT NAME TOTAL DEPOSIT


VALIDATION

ABC Bank
FOR FUND TRANSFER ONLY
WITHDRAWAL SLIP
CREDIT TO ACCOUNT NUMBER
FUND TRANSFER SLIP

TYPE OF TRANSACTION WITHDRAWAL FUND TRANSFER


ACCOUNT NAME
CURRENCY TYPE OF ACCOUNT DATE

C PHP C USD C SAVINGS


I/ We hereby declare under penalties of perjury that my/our co-depositors is/are still living.

C CHECKING
OTHERS ______
C C OTHERS
SIGNATURE OF DEPOSITOR/S
WITHDRAWAL/ TRANSFER FROM ACCOUNT NUMBER
I/ We hereby authorize the person whose signature appears below to make this withdrawal for
me/u

ACCOUNT NAME
SIGNATURE OF DEPOSITOR/S

AMOUNT IN WORDS

_________________________ _________________________
NAME OF REPRESENTATIVE SIGNATURE OF REPRESENTATIVE
IN FIGURES
VERIFIED BY: RECEIVED BY:

VALIDATION
APPROVED BY:

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