THE MAURITIUS CIVIL SERVICE MUTUAL AID ASSOCIATION LTD.
PAYMENT FORM
Customer Name: …………………………………
A. CHEQUES
|
BANK
|
NO
|
AMOUNT (Rs)
|
CASHIER'SSIGNATURE |
|
|
|||
|
TOTAL
|
|
||
AMOUNT IN WORDS: …………………………………………………………………………………
SOURCE OF FUND
AS PER THE FINANCIAL INTELLIGENCE AND ANTI-MONEY
LAUNDERING ACT 2002.
PLEASE STATE SOURCE OF FUNDS: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
| NATURE OF TRANSACTION: |
FIXED DEPOSIT
|
|
LOAN REPAYMENT
|
|
||
|
SHARES
|
|
OTHERS
|
|
PAYMENT FORM
B. CASH
|
RUPEES
|
CTS
|
RUPEES
|
CTS
|
CASHIER'S SIGNATURE
& STAMP |
|
2000
|
||||
|
1000
|
||||
|
500
|
||||
|
200
|
||||
|
100
|
||||
|
Others
|
||||
|
TOTAL
|
||||
AMOUNT IN WORDS: ………………………………………………………………………………………………………………
SOURCE OF FUND
AS PER THE FINANCIAL INTELLIGENCE AND MONEY
LAUNDERING ACT 2002.
PLEASE STATE SOURCE OF FUNDS: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
| NATURE OF TRANSACTION: |
FIXED DEPOSIT
|
|
LOAN REPAYMENT
|
|
||
|
SHARES
|
|
OTHERS
|
|
| SIGNATURE: …………………………………………………… |
DATE: ……/ ……/
……
|