• Payment Declaration Form

    Payment Declaration Form

  • Recipient Information:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Payer Information:

  • Format: (000) 000-0000.

  • Payment Information:

  • Mode of Payment
  • Payment Frequency

  • Declaration:

  • I/We declare that the information declared herein are true and correct to the best of my knowledge. I/We further declare that the amount paid has been sourced through legitimate means and in no way was made through anything contrary to laws, morals, public order, or public policy.

     

     

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