Www.raquelpawnshop.website
CIS Bayad Center, Inc.
Business Solutions Center, Meralco Complex, Ortigas Avenue, Pasig City
Tel: 6725757, Fax: 6502850 Email Address: bayadcenter@
EDIT/DELETE REQUEST, INCIDENT REPORT & WAIVER FORM
[pic] Altered Check [pic] Staled Check [pic] Wrong Amount [pic] Double Posting
[pic] Cancelled Payment [pic] Unsigned Check [pic] Wrong Biller [pic] System Error
[pic] Cash encoded as Check [pic] Wrong Bank Code [pic] Wrong Bill Presented [pic] No Teller Code
[pic] Check encoded as Cash [pic] Wrong Check Number [pic] Wrong System Date [pic] Unique Constraint
[pic] Post Dated Check [pic] Wrong Amount in [pic] Erroneous Deposit Amount Php ____________________________
Words & Figures [pic] Over Deposit Depository Bank Acct #____________________
[pic] Under Deposit Date of Deposit __________________________
[pic] Others, please specify __________________________________________________________________________________
|Date of Request | |
|Biller | |
|Transaction Date | |
|Account Number | |
|Mode of Payment: [pic] Cash / Amount | |
| [pic] Check / Amount | |
|Check Details (Bank Name & Check No.) | |
|TPA Code | |
|Bayad Center Name | |
|Name of Customer or Representative | |
|Signature of Customer or Representative | |
|Contact Number of Customer or Representative | |
INCIDENT REPORT
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
DATE & REASON FOR REVISION OF EDIT/DELETE REQUEST, INCIDENT REPORT & WAIVER FORM
DATE: ____________________
REASON:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
WAIVER
I will take full responsibility in case the customer has any dispute in the posted transaction versus the validated amount in the statement of account or payment form. I will not hold Bayad Center liable for the difference, if any.
Requested by: Approved by:
_________________________________ __________________________________
Teller Supervisor/Manager
(Signature over Printed Name) (Signature over Printed Name)
................
................
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