title: stop payment of cheque / pay order · 2017. 11. 6. · to pay order # kindly cancel the...
TRANSCRIPT
Date:
The Manager, United Bank Ltd.
Branch:
Emirate: , UAE Title:
Cheque(s) serial #
Issue Date:
Reason for Stop Payment:
Amount:
Lost
Pay Order # to
Kindly Cancel the enclosed: FDD#
Stop Payment of Cheque / Pay Order
Thank you.
For Bank Use Only
Charges Recovered:
NA
Police Report
Original Instrument
Account Holder Signature/Company Stamp
Account Holder Name Joint Account Holder Name
Joint Account Holder Signature/Company Stamp
d d / m m / y y y y
d d / m m / y y y y
Waived
Stop Payment Marked
PO / FDD cancelled
Acct Credited Cash Paid
Yes
In Person by Customer Through Mail/Messenger Through Fax
Reset
Pay Order# Original enclosed: Yes No
The amount (less bank charges) may be:
App Received By Sign Verified By Input By Supervised by:Name & SignatureName & SignatureName & SignatureName & Signature
Other
Beneficiary:
Issue Date:
Reason for Stop Payment:
Amount:
Lost
d d / m m / y y y y
Other
Beneficiary:
Credited to my/our above account Paid to me/us in Cash.
My / Our Account Number
UA
E - 0
0012
- 04
2016
-V1