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FMDA-0501-04

APPLICATION for TERMS AND CONDITIONS


MC/DD/TT/FXCY NOTES
CONDITIONS ON FUND TRANSFER / PAYMENT
DATE: REQUEST FOR:
Demand Draft Telegraphic Transfer UnionBank of the Philippines (the Bank) will take the customary steps in the fund transfer / payment subject of
August 25, 2015 this Application. The Bank is free to make use of any correspondent, sub-agent or any other agency, but in no
X Manager's Check Foreign Currency Notes case shall the Bank of any of its correspondents be liable for mutilations, interruptions, omissions, errors, non-
transmission, or delays occurring in the mails, or on the part of any telegraph, cable, or wireless company, or any
CURRENCY AND AMOUNT MODE OF PAYMENT employee of such company, or for any reason or cause whatsoever beyond the control of the Bank or its
correspondents or agents.
NUM

Cash On-us Check X Debit Account

Php49,680.00 If Debit Account, Account Number


WORDS

### The Bank may send any message relative to this fund transfer / payment in explicit language, codes or ciphers
and shall not be liable for errors, neglects or defaults of an of its correspondents, sub-agents, or other agency.
001460001063
PURPOSE Any draft issued will be advised immediately to the drawee. The drawee will not be responsible should the draft
be dishonored as a result of delay in presentation of late arrival or non-arrival of advice of the drawing or for any
DST PAYMENT other reason beyond the drawers control.

DETAILS FOR MC / DD APPLICATIONS The client Application assumes / accepts full responsibility for fraudulent or erroneous instructions provided
that the Bank has complied with the terms and conditions set forth in this application.
Payee Name
CONDITIONS ON FOREIGN CURRENCY REMMITANCES
LBP FAO BIR, TIN 002305416001 COMMUNITIES CAGAYAN INC.
Account Number Unless it is otherwise expressly agreed in writing, the Bank may, at its discretion, convert into foreign values the
funds received from the Applicant at the Banks selling rate on the day such funds are received. The Banks
statement in writing that it has effected such conversion shall be conclusive for all intents and purposes.

CONDITIONS ON ISSUANCE OF MANAGERS CHECK / DEMAND DRAFTS


Address and Contact Number

Onghoc Bldg.,Montilla Blvd. cor.Butuan City, Agusan del Norte If the Manager's check (MC) or Demand Draft (DD) is lost, stolen, or destroyed, the Applicant shall provide the
Bank with a bond indemnifying the Bank against any and all liability whatsoever with respect to the lost, stolen,
(085) 342-6907 or destroyed MC / DD as a condition precedent for the replacement by the Bank of such lost, stolen, or
destroyed MC / DD issued by the Bank. MCs however, shall not be subject to Stop Payment in case of loss.
Receiving Bank Intermediary Bank
N.A. N.A.
Bank Name The Client Applicant assumes / accepts full responsibility for Managers Checks issued in favor of Government
Offices provided that the Bank has complied with all the requirements in processing such a transaction.
N.A. N.A.
Address/Ref. No.
The Client Applicant shall also assume / accept full responsibility for fraudulent or erroneous instructions
relative to the MC / DD issuance provided that the Bank has complied with the terms and conditions set forth in
This application is subject to the terms and conditions on the reverse side hereof to which I / We this application.
agree. If payment is to be debited from a deposit account, this will authorize the Bank to debit my /
our account for the payment of the MM / DD / TT / FX Notes including Bank charges. Further, I / We
declare under the penalties of perjury that my / our co-depositors is / are still living.

Emelia Lustado/Gemma Ytang/Fritzie V. Loayon/Arthuro Secuya/Ma. Teresa Tumbaga/ Roberto Fabrique Jr./Marlon Esc
Signature of Applicant over Printed Name

FOR AUTHORIZED REPRESENTATIVES ONLY


This will authorizeMary Joan Estrella/Thara Camelle Abonacion whose signature appears below,
to acknowledge receipt of the above instrument. This will hold the Bank free and harmless from any liability
whatsoever that may arise in the event of any loss or unauthorized negotiation of the instrument.

ENL/GOY/ FVL / ACS / MTPT / RDFJ/MB


Signature of Applicant Signature of Representative

Processed by: Approved by: MC / DD / Notes Received By:


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