Service Slip
For Bank’s Use Only
Approved by: Date:
SPO Cancellation
Check Number Reason
SPO Application
Check Number Amount Date of Check
Reason Payee
Addressee
Purpose
Address
Amount (if applicable)
Additional information (if applicable)
Kindly accomplish if requested checkbook is to be received by a representative.
I hereby authorize __________________________________________________ whose signature follows _____________________________________________
delivery of checkbook on my behalf.
to accept
Named Checkbook Requisition
No. of Checkbooks Personal Commercial
I/We have read and hereby authorize the Bank to carry out this instruction and agree to be
governed by your terms and conditions printed below. Furthermore, I/we authorize the Bank to
debit the above account for payment of applicable fees and charges to implement my/our request.
Mode of Payment
Cash Check Debit Account No.
Accountholder’s Signature over Printed Name Signature over Printed Name
Acknowledgement Receipt
Terms and Conditions
1. Depositor Information and Consent
a.
b.
Foreign Currency Deposit Act and The General Banking Law of 2000, respectively).
c.
B. Stop Payment Order
1. The validity of the Stop Payment Order (“SPO”) shall be six (6) months from the date the application is received by BDO Unibank, Inc. (BDO).
2. SPO application and renewal fees shall be collected as deemed applicable by BDO.
3. The Depositor agrees and undertakes to:
a.
“BDO Persons”) free from all liability and to forever indemnify BDO and all BDO Persons for all costs, damages, and expenses for which it may be liable in relation to the check described herein, including but not
limited to such liability, costs, damages and expenses arising from:
i. non-payment of the check during the existence of the SPO;
ii. payment of the check contrary to the SPO if such payment occured through the fault or negligence of the Depositor including but not limited to instances when the Depositor failed to provide any information
regarding the check in this application;
iii. payment of the check made before the time SPO was received by BDO.
b. Accomplish a new SPO Application Form for renewal before the lapse of the six (6) month period.
c. Accomplish the SPO Cancellation portion of this form for any request for cancellation.
4.
Account Name Account Number
Checkbook Requisition Stop Payment Order (SPO) Application SPO Cancellation
DateBranch
Please use separate form for each type of transaction.
