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TRANSACTION

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This is our standard form client agreement upon which we intend to rely. For your own benefit and protection, you should read Ihe terms and conditions which apply to your transaction on the reverse of the torm carefully before signing below. Ifyou do not understand any point please ask for further information. I acknowledgereceipt of the M'oneyGramtransfer as provided above. . . ~mi!!fl'lfl.fflIn(({]mi~lI!''<t'gpflllll. ~7i~H3C.99fU~H!l'*IIt~lt!l, illl1l!$\;ff!llllIlll"l8m~;m99~\;Z~~lfij~f.f (Ul~""<I!99~ilii), ;Z It;ti''F1J~:g. ~D!illolMf:ffol-Ili"'mflll, ~~"'i!-!J;99j1fiiR. i!!il\ll8l:!l..t~m:;E, IIli:IlJt MoneyGram Il!!~.
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For transaeflens requiring additional information /lit!1!13l'~IlIi~

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MoneyGram may use the informationprovidedon this form forthe purpose of sendinll.you further informationabout the services offeredby Money,.Gram. Ifyou wish to receivesuch information,please tickthis box./ l!ll!!j{'iJIllHtJllJlt'l!<<I!VJ(({]j,""1>,I~~ifJ!lllllll!ll!!~m#HfJHBl1YHfJ;ltffum,",,o :o1~<ljHI11&!ijIJ Iltnm,"", iii\'1;iJl!llltmo / MoneyGram 3H3 MaHTaA erceu M3A33nn~j;ir TaHA MoneyGram-blH Y3yynA3r y"n4~nr33HYYA~j;iH
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If receiver is a US citizen, social security no / jzQ1&~A;ll!:~1lll0R, l1!i'!)(i!.tj.ifl~~lJklilO I X3P3B Ten6ap xyn33H asarv Hb AHY-bIH Hpr3H 60n Social security nyraapsrr 6H'IH3 vv-

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For our complaints handling procedure, see reverse

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