BE IT KNOWN, that the undersigned hereby acknowledges receipt of the sum of _____________________on ____________________date as full payment of (state the reason for payment) paid by European Banking Regulators (E.B.R) through (select method of payment):
☐ Cheque No. _____________dated ______________in favor of _________________________
☐ Account No.___________________________
☐ Other _____________________________
E.B.R is hereby released from any claims pertaining to the said amount.
The signature on this document represents understanding and agreement with this contract, capacity to contract, and willingness to be legally bound herein.
Acknowledgement by: _______________________(full name) __________________ (signature)
Witness: __________________________________(full name) __________________ (signature)
Signed this __________________day of _____________________20, _____________________
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