PAYING BANK RECEIPT - Philippine Deposit Insurance …
PHILIPPINE DEPOSIT INSURANCE CORPORATIONPAYING BANK RECEIPT Date PaidClearing Account No. 1782-2220-97Paying Bank Reference No. IMPORTANT: This receipt must cover assessment related items only. ASD ADEF INT/PNY OTHCOLLECTING BANK Land Bank of the PhilippinesBRANCHSignature over Printed Name of Remitting Entity RepresentativeREMITTANCE RECEIVED FROM (Name of Bank):Total Amount Remitted in Pesos (In Words)Payment Received by: (Teller’s Name)NATURE OF REMITTANCEAmount (P)TELLER’S VALIDATION1. Assessment Due (ASD)Amount appearing herein should tally with the RCS2. Assessment Deficiency (ADEF)3. Interest/Penalty (INT/PNY)4. Others: (specify) (OTH)Note: This serves as Confirmation Receipt if machine validatedFORM OF REMITTANCEAMOUNT PCASHCHECKName of Bank/BranchCheck NumberFUND TRANSFERName of Bank/BranchAccount NumberOriginal – LBP’s CopyNote: Reproduction of this form shall be the responsibility of the remitting bank. This form is downloadable from the PDIC website.Duplicate – Remitting Entity (to be submitted to PDIC)Triplicate – Remitting Entity’s Copy1028700-342265 ................
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