LBP REMITTANCE CO

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:

Remittance:
Charge:
Total Paid:
Exchange Rate:
Total Amount:

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