Bayad Center Transaction Form

Here's a photo of a Bayad Center Transaction Form:

Here are the details of the form:


                                  Please provide all required information below

Account Name (Surname, Given Name, Middle Name)

Present Address  _______________________________                       
__________________________Contact No. ________

                 TRANSACTION DETAILS

(  ) Bills Payment     (  ) Others _______

Biller _______                         Date _______
Amount Due _______              Due Date _______
SOA/Invoice No. _______       Statement Date _______

Account Number _______


ID Number _______
Payment Type (  ) Contribution   (  ) Short Term Loan    (  ) Real Estate
Payor Type  (  ) SE    (  ) VM   (  ) )OFW   (  ) Others_______
Loan Acct No. _______                Loan Type _______
Applicable Month(s)  From _______ To _______ Year_______
Contribution/Month _______  Total Amount_______

                PAYMENT DETAILS

(  ) Cash   (  ) Check   (  ) Cash & Check   (  ) Credit Card
Cash Php _______         Check No._______
Check Php _______           Bank_______
Total Php _______           Branch _______
Credit Card No. _______  Expiry Date _______

DECLARATION:  The information provided above and documents hereby submitted have been made in good faith, verified correct to the best of my knowledge, pursuant to any Laws and Regulations applicable. I fully understand that CIS BAYAD CENTER INC. is authorized to accept and process payments and documents submitted through its branches.

                              Signature over printed name


            Machine Validation
This will serve as your receipt when machine validated


If you're paying your SSS Loan, fill up the following:

Account Name:
Present Address:
Contact No.:
Biller: SSS
Date:  Aug 20, 2014
Amount Due:  1,080.00
ID Number: SSS No. 04-800804004
Payment Type: VM
Loan Acct. No. SSS No.  04-800804004
Loan Type: Salary
Applicable Month(s):  August 2014
Total Amount:  1,080.00
(  ) Cash
Cash Php:  1,080.00
Total Php:  1,080.00
Signature over printed name

Note: Many Bayad Centers do not accept payments for the previous month, even if you're still within your payment deadline based on the last digit of your SSS No.


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