"Electronic Verification of Documents, Certificates and Instruments Approved by Riyadh Chamber "

No: GDBC-291000000796-1429H

Date(g): 21/12/2008 | Date(h): 24/12/1429

Effective from 2008-12-28 - Dec 27 2008
To view other versions open the versions tab on the right

Slip of dishonored check

Bank Name /

Branch/............

Date: / / 14 H / /20 AD

We can not honor Chech No. ( ) Dated( )( )

Amount () Drawn on Account No.( )( )

Full Name of Drawer /

No. of Drawer's Civil Register/

Name of Check signatory If he/she Is an agent/

Please contact (.......................................)

For the reasons specified below:

1	Drawer's Account	( ) No Balance ( ) Balance is not suffient
		( ) Closed( ) blocked( ) frozen ( ) Not available ( ) Not matching ( ) Incomplete ( ) Drawer full signature required for change made on □ date □ Amount □ beneficiary
2	Drawer's signature
		( ) missing( ) stale
3	Check Date
4	Check Amount	( ) Amount Is missing ( ) Amount In figures is missing
		( ) Not Payable by US
		( ) Suspended due to: □ Eligibility □ bankruptcy □ Loss
5	The Check	( ) Non-transferable
		( ) Drawn against payment instruments not collected yet
		( ) Not previous arrangements were made to authorize payment
		( ) Not previous arrangements were made to authorize payment
		( ) Irregular crossing( ) Irregular writing-
		( ) distorted( ) damaged( ) torn out
		( )Contact drawer to adjust the check data electronically
		( ) The check named to several beneficiaries and the amount is recorded to one beneficiary
		( ) Valid ID is required from Beneficiary
		( ) The location or the place of check issuance is not available ( ) Endorsement is not serialized
6	On Check
		( ) Endorsement date presented in violation of the Commercial Paper Law
		( ) Non-endorsable
		( ) Endorsee name is different from the Beneficiary name
		( ) Endorsee signature missing
7	Clearing house stamp	( ) not completed ( ) missing ( ) must be cancelled
8	others

Authorized Signatures

Official Seal

Employee Name

Ipos No.

Date

Signature