Payroll Disclosures

Electronic Fund Transfer Act (Regulation E) 12 CFR 1005

A-30 Form 1.11.12

Payroll Disclosures

OMB: 3170-0014

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A-30 – Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency (§ 1005.31(b)(1))

ABC Company

1000 XYZ Avenue
Anytown, Anystate 12345

Today’s Date: March 3, 2013

NOT A RECEIPT

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




File Typeapplication/msword
AuthorV. Wong
Last Modified ByMandie Aubrey
File Modified2012-01-11
File Created2012-01-11

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