LBP REMITTANCE CO.
A subsidiary of Land Bank of the Philippines
  
Fund Transfer Application Form
Remitter's Name: 
Address:  

City / State / Zip Code: 

Telephone Number:  

Beneficiary's Name:  

Beneficiary's Address:


Telephone Number:  
Date: 

Amount of Remittance:  

Remittance Charge:         

Total Amount Paid:        

Exchange Rate in Peso:  

Total Amount in Peso:   

 
Remittance Mode:
  1.
Cash Door to Door (pesos)
  2.
Credit to LBP Account         Peso     USD
  3.
Credit to Local Bank Account
  4.
Pick-up at any Land Bank Branch
  5.
Issuance of Manager's Check for Pick-up at LBP Head Office

 
Bank Name:  
Branch Name: 
Account No.:  
Others: 
 
Comment:
Remitter's Signature:
  

 
Received by: 
 

Enclosed with this form is:

1. Remitter's Check #_____  
  Made Payable to: LBP Remittance Co.
  Mailed to:  Ms. Loreta Poserio
LBP Remittance Company
8215 A Woodman Ave.
Panorama City, CA 91402
2. Copy of Remitter's ID (Driver's License ~or~ Already on File with LBP)

Ms. Loreta Poserio's Tel. # (818) 989-2720 ~ Fax # (818) 989-2783

Ms. Loreta Poserio:  Please Confirm Transfer of Funds to Remitter's Address

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