Document
Transaction Receipts
ICR 201212-3170-004 · OMB 3170-0014 · Object 36864201.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Transaction Receipts |
| Author | V. Wong |
| Last Modified By | Writer |
| File Modified | 2012-01-11 |
| File Created | 2026-07-16 |
| Conversion State | complete |
Extracted Text
A-31 – Model Form for Receipts for Remittance Transfers Exchanged into Local Currency (§ 1005.31(b)(2)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: March 3, 2013 RECEIPT SENDER: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 222-555-1212 RECIPIENT: Carlos Gomez 123 Calle XXX Mexico City Mexico PICK-UP LOCATION: ABC Company 65 Avenida YYY Mexico City Mexico Confirmation Code: ABC 123 DEF 456 Date Available: March 4, 2013 Transfer Amount: $100.00 Transfer Fees: +$7.00 Transfer Taxes: +$3.00 Total: $110.00 Exchange Rate: US$1.00 = 12.27 MXN Transfer Amount: 1,227.00 MXN Other Fees: -30.00 MXN Other Taxes: -10.00 MXN Total to Recipient: 1,187.00 MXN You have a right to dispute errors in your transaction. If you think there is an error, contact us within 180 days at 800-123-4567 or www.abccompany.com. You can also contact us for a written explanation of your rights. You can cancel for a full refund within 30 minutes of payment, unless the funds have been picked up or deposited. For questions or complaints about ABC Company, contact: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.gov Consumer Financial Protection Bureau 855-411-2372 855-729-2372 (TTY/TDD) www.consumerfinance.gov