PLAI Official Receipt Report
Region *
Indicate the region where the member belongs
OR No. *
Date
MM
/
DD
/
YYYY
RECEIVED from - Last Name (Individual) or Name of Institution (Company) *
Individual (Indicate First Name and/or Middle Name/Initial below)
First Name
Middle Name/Initial
(not required)
Institution/Address
Tel. No.
Format (63-2-6214942)
PRC Registration/License No.
Amount *
Please issue separate receipt for Membership Fee (500) and Annual Dues (300) - PLEASE DO NOT ISSUE 800 pesos in 1 (one) receipt. Ex. If member pays annual dues for 2 years. Indicate Amount as Others 600.00 Check Annual Dues in Payment Type and Indicate [2017 and 2018]
Amount *
Please issue separate receipt for Membership Fee (500) and Annual Dues (300) - PLEASE DO NOT ISSUE 800 pesos in 1 (one) receipt. Ex. If member pays annual dues for 2 years. Indicate Amount as Others 600.00 Check Annual Dues in Payment Type and Indicate [2017 and 2018]
Payment Type *
Indicate specific details in the next item.
Payment Details
Indicate the YEAR (paid) only for Annual Dues/Membership Fee/ or the NAME of the Conference/Seminar/Forum Name/ Category of Participants for Conference Registration Fee/
Details for Check and Bank Transfer /Remarks
Payment Form
Clear selection
Paid in what Region
Answer only this item if the payment was made in PLAI National Office or Other Region. Example - Juan de la Cruz is from Iloilo (Region VI - should be indicated above) but paid his membership annual dues in PLAI Office - PLAI-NCR (OR series issued under PLAI NCR). This is to collate later on records for division of shares. Although the receipt was issued by PLAI NCR - 50% should be returned to Region VI.
Notes/Remarks
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