THE COUNTRY BANK

COLLECTION LIST
COLLECTION LIST
CONTROL FORM: 004-17-51J123456-cl00001

Account Type: Saving Account Account Number:

Account Name: Juan C. Dela Cruz

For the month of September 2017

DATE AMOUNT SIGNATURE DATE AMOUNT SIGNATURE DATE

01 11 21

02 12 22

03 13 23

04 14 24

05 15 25

06 16 26

07 17 27

08 18 28

09 19 29

10 20 30

31

This form was issued on 08/01/2017

TOTAL DEPOSIT:

BALANCE RECONCILIATION (For Bank Use Only)

Requested by: Confirm by: Check by: Noted by

 _______________________ _______________________ __________
Depositor Cash Officer Brach Accountant Branch Ma

Period Covered of Statement:

Date Requested:

NOTES: Reconciliation of balances should be provided by the Bank Statement from the period covered requested duly signed and app
 THE COUNTRY BANK
COLLECTION LIST
COLLECTION LIST
CONTROL FORM: 004-17-51J123456-cl00001

Account Type: Saving Account Account Number:

Account Name: Juan C. Dela Cruz

For the month of September 2017

DATE AMOUNT SIGNATURE DATE AMOUNT SIGNATURE DATE

01 11 21

02 12 22

03 13 23

04 14 24

05 15 25

06 16 26

07 17 27

08 18 28

09 19 29

10 20 30

31

This form was issued on 01/00/1900

TOTAL DEPOSIT:

BALANCE RECONCILIATION (For Bank Use Only)

Requested by: Confirm by: Check by: Noted by

 _______________________ _______________________ __________
Depositor Cash Officer Brach Accountant Branch Ma

Period Covered of Statement:

Date Requested:

NOTES: Reconciliation of balances should be provided by the Bank Statement from the period covered requested duly signed and app
 THE COUNTRY BANK
LLECTION LIST

51-12345-6

DEPOSITOR'S FILE

AMOUNT SIGNATURE

y: Check by: Noted by:

___________ _______________________ ________________________
Brach Accountant Branch Manager

nk Statement from the period covered requested duly signed and approved.
 THE COUNTRY BANK
LLECTION LIST

51-12345-6

COLLECTOR'S FILE

AMOUNT SIGNATURE

y: Check by: Noted by:

___________ _______________________ ________________________
Brach Accountant Branch Manager

nk Statement from the period covered requested duly signed and approved.