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Created December 15, 2016 14:01
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PrintReciept.html
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<!-- saved from url=(0093)https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/10.10.1.3.83 -->
<html xmlns="http://www.w3.org/1999/xhtml"><head><meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<meta name="generator" content="Adobe GoLive">
<title>InstaPago Receipt Reprint / Reimpresion Del Recibo</title>
<link name="stylePage" rel="stylesheet" type="text/css" href="./receipt_style.css">
<link name="stylePrint" href="./receipt_style_print.css" rel="stylesheet" type="text/css" media="print">
</head>
<body>
<form method="post" action="https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/11.6">
<table class="noprint" cellpadding="0" border="0" cellspacing="0">
<tbody><tr valign="bottom" height="9" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<td width="30">
<b> <a href="javascript:window.print()">PRINT</a></b>
</td>
<td width="80">
&nbsp; <a href="https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/11.6.1.1"><b>RESEND FAX</b></a>&nbsp;
</td>
<td width="395">
&nbsp;
</td>
<td width="30">
&nbsp;<a href="https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/11.6.7.1"><b>FAX</b></a>&nbsp;
</td>
<td width="80">
<b>
&nbsp;<a href="https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/11.6.9.1">MINI RECEIPT</a>&nbsp;
</b>
</td>
<td width="47" align="RIGHT">
<b>
&nbsp;<a href="https://10.72.12.63/cgi-bin/WebObjects/CSA.woa/16/wo/x7voSlseu4se2Pgxr532W5PvP0P/11.6.11">CONTINUE</a>&nbsp;
</b>
</td>
</tr>
</tbody></table>
<!-- PRE-RECEIPT -->
<table width="662" border="0" cellspacing="0" cellpadding="0">
<tbody><tr border="1" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
<td colspan="3" align="LEFT" valign="BOTTOM" width="622" style="bottom">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td align="CENTER" valign="BOTTOM" style="bottom">
&nbsp;
</td>
<td align="CENTER" valign="BOTTOM" style="bottom">
<b>CUSTOMER COPY (COPIA PARA EL CLIENTE) **RECEIPT REPRINT / REIMPRESIÓN DEL RECIBO**</b>
</td>
<td align="CENTER" valign="BOTTOM" style="bottom">
&nbsp;
</td>
</tr>
</tbody></table>
</td>
</tr>
<!-- FIRST ROW -->
<tr height="57">
<td align="CENTER" class="lefttop right">
<img height="43" width="175" border="0" src="./UNITELLER_RECEIPT_LOGO.JPEG"><br>
<font style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
<b>
Tel:1-800-495-5674
/
Fax:1-866-235-3279
</b>
</font>
</td>
<td class="top" valign="TOP">
<table width="230" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="30">
<td width="80" align="RIGHT" valign="MIDDLE" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
SERVICE TYPE <br>&nbsp;(TIPO DE SERVICIO)
</td>
<td width="150" valign="MIDDLE" style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>&nbsp;LRC-CTA BANORTE</b>
</td>
</tr>
<tr height="18">
<td width="80" align="RIGHT" valign="TOP" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
PRICE CHOICE <br>&nbsp;(TIPO DE PRECIO)
</td>
<td width="150" valign="TOP" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
&nbsp;REGULAR
</td>
</tr>
</tbody></table>
</td>
<td class="lefttop right" valign="TOP">
<table width="230" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td width="80" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
DATE (FECHA)
</td>
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<div align="RIGHT">
Tue 08/Nov/2016 03:20:30 AM EST
</div>
</td>
</tr>
<tr height="40">
<td width="80" valign="BOTTOM" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
<div align="left">
TRANSACTION NO <br>&nbsp;(NO DE TRANSACCION)
</div>
</td>
<td align="right" valign="BOTTOM" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b><font size="3">67094422222</font></b>
</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td width="202" class="box" align="center" valign="TOP">
<table width="200" height="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="70">
<td class="bottom" valign="MIDDLE">
<div align="center" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
AUTHORIZED SERVICIO UNITELLER AGENT<br>
(AGENTE AUTORIZADO DE SERVICIO UNITELLER )
</div>
<div align="center" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<b>Xoom Corporation</b><br>
<font style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
<b>San Francisco, CALIFORNIA</b>
</font>
</div>
<div align="center" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<b>PHONE &nbsp;(TEL): &nbsp;8778151531, 4152814290</b>
</div>
</td>
</tr>
<tr height="50">
<td valign="MIDDLE">
</td>
</tr>
</tbody></table>
</td>
<td width="230" align="left" class="top bottom">
<table height="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td width="230" valign="BOTTOM" colspan="2" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
REMITTER INFORMATION (INFORMACION DEL REMITENTE)
</td>
</tr>
<tr>
<td width="10">&nbsp;
</td>
<td width="220">
<font style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>kapilrrraj verma</b><br>
</font>
<font style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b>PHONE &nbsp;(TEL): </b>9956852140<br>
1543 N 67TH<br>
Dwarka,
CALIFORNIA,
90047,
USA</font>
</td>
</tr>
<tr>
<td colspan="2" height="5">
</td>
</tr>
<tr>
<td width="230" valign="BOTTOM" colspan="2" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
BENEFICIARY INFOMATION (INFORMACION DEL BENEFICIARIO)
</td>
</tr>
<tr>
<td width="10">&nbsp;
</td>
<td width="220">
<font style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>vikyy kumar rawat sharma</b><br>
</font>
<font style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
PHONE &nbsp;(TEL):
2323445456<br>
D-1 New Delhi<br>
DELHI,
BAJA CALIFORNIA NORTE,
12323,
MEXICO</font>
</td>
</tr>
</tbody></table>
</td>
<td width="230" align="left" valign="BOTTOM" class="box">
<table width="230" height="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="18">
<td width="100" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;TRANSFER AMOUNT <br>&nbsp;(CANTIDAD DE ENVIO)
</td>
<td width="95" align="right" style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
$ 1.00
</td>
<td width="35" align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
USD
</td>
</tr>
<tr height="18">
<td style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;TRANSFER FEE <br>&nbsp;(CARGOS POR ENVIO)
</td>
<td style="font-size:11px; font-family:Arial, Verdana, Sans-serif" align="right">
+ 1.90
</td>
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif" align="CENTER">
USD
</td>
</tr>
<tr height="23">
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
&nbsp;<b>TOTAL&nbsp;(TOTAL)</b>
</td>
<td class="top2" align="right" style="font-size:14px; font-family:Arial, Verdana, Sans-serif">
<b>$ 2.90</b>
</td>
<td class="top2" align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b>USD</b>
</td>
</tr>
<tr height="23">
<td valign="MIDDLE" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;EXCHANGE RATE <br>&nbsp;(TASA DE CAMBIO)
</td>
<td align="CENTER" colspan="2" style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
USD
$ 1.00 =
12.0000&nbsp;
MXN
</td>
</tr>
<tr height="23">
<td style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;<b>TOTAL TO RECIPIENT <br>&nbsp;(TOTAL AL DESTINATARIO)</b>
</td>
<td align="right" style="font-size:14px; font-family:Arial, Verdana, Sans-serif">
<b>12.00</b>
</td>
<td align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b>MXN</b>
</td>
</tr>
<tr>
<td width="80" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
DATE AVAILABLE <br>&nbsp;(FECHA DISPONIBLE)
</td>
<td colspan="2" style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
<div align="RIGHT">
Tue 08/Nov/2016 <b>*</b>
</div>
</td>
</tr>
</tbody></table>
</td>
</tr>
<!-- DISCLAIMER ROW -->
<tr valign="TOP" height="10">
<td colspan="3" height="10" align="RIGHT" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<div style="font-family:Arial, Verdana, Sans-serif; text-align:RIGHT">
<font style="font-size:11px; font-family:Arial, Verdana, Sans-serif"><b>*</b></font>
Operating hours and banking system availability permitting (Si horas de operacion y disponibilidad del sistema bancario permiten)
</div>
</td>
</tr>
<tr valign="TOP" height="18">
<td colspan="3" height="18" align="JUSTIFY">
<div style="font-family:Arial, Verdana, Sans-serif; text-align:justify">
<font style="font-size:9px;">You have a right to dispute errors in your transaction. If you think there is an error, contact us within 180 days at 1.800.495.5674 or <u>www.uniteller.com</u>. You can also contact us for a written explanation of your rights. </font><font style="font-size:9px;">You can cancel for a full refund within 30 minutes of payment, unless the funds have been picked up or deposited. </font><font style="font-size:9px;">For questions or complaints about Servicio UniTeller Inc. ("UniTeller"), contact: </font><font style="font-size:9px;"><b>Money Transmitter Division of California Dept. of Business Oversight :</b> 866-275-2677 http://www.dbo.ca.gov/Licensees/money_transmitters/default.asp&nbsp;</font><font style="font-size:9px;"><b>Consumer Financial Protection Bureau:</b> 855-411-2372 / 844-729-2372 (TTY/TDD) www.consumerfinance.gov </font><font style="font-size:9px;"><u><b>RIGHT TO REFUND:</b></u> You the customer are entitled to a refund of the money to be transmitted as the result of this agreement if Servicio UniTeller Inc. ("UniTeller") does not forward the money received from you within ten (10) days of the date of its receipt, or does not give instructions committing an equivalent amount of money to the person designated by you within 10 days of the date of receipt of funds from you unless otherwise instructed by you. If your instructions as to when the moneys shall be forwarded or transmitted are not complied with and the money has not yet been forwarded or transmitted, you have a right to a refund of your money. If you want a refund, you must mail or deliver your written request to our selling agent whose name and address is described on your customer receipt or to UniTeller at 218 Route 17 North-Suite 402, Rochelle Park, NJ 07662. If you do not receive your refund, you may be entitled to your money back plus a penalty of up to $1,000 and attorney's fees pursuant to Section 2102 of the California Financial Code. </font><font style="font-size:9px;"><u><b>PRIVACY POLICY:</b></u> UniTeller does not disclose or sell your personal information to unaffiliated parties except (i) as required by law, (ii) to government agencies, (iii) to entities that process or pay transactions or provide other services or products to or for us, or (iv) as deemed necessary or appropriate by UniTeller to service you. </font><font style="font-size:8px;"><u><b>TERMS:</b></u> In addition to the service fees applicable to this transaction, a currency exchange rate is being applied. Any profit in the difference between the rate given to customers and the rate received by UniTeller is kept by UniTeller. UniTeller will have no liability for return of funds or any claims under any circumstances if the account number is not correct for remittances sent to bank accounts. </font>
</div>
<div style="font-family:Arial, Verdana, Sans-serif; text-align:justify">
<font style="font-size:9px;">Usted tiene derecho de discutir errores en su transaccion. Si cree que hay un error, contactenos dentro de 180 dias al 1.800.495.5674 o <u>www.uniteller.com</u>. Tambien puede contactarnos para obtener una explicacion escrita de sus derechos. </font><font style="font-size:9px;">Puede cancelar el envio y recibir un reembolso total dentro de 30 minutos de haber realizado el pago, a no ser que los fondos hayan sido recogidos o depositados. </font><font style="font-size:9px;">Para preguntas o presentar una queja sobre Servicio UniTeller Inc. ("UniTeller"), contacte a: </font><font style="font-size:9px;"><b>Money Transmitter Division of California Dept. of Business Oversight :</b> 866-275-2677 http://www.dbo.ca.gov/Licensees/money_transmitters/default.asp&nbsp;</font><font style="font-size:9px;"><b>Consumer Financial Protection Bureau:</b> 855-411-2372 / 844-729-2372 (TTY/TDD) www.consumerfinance.gov </font><font style="font-size:9px;"><u><b>DERECHO A REEMBOLSO:</b></u> Usted como cliente, dentro de los terminos de este acuerdo, tiene derecho a un reembolso de su dinero, si Servicio UniTeller Inc. ("UniTeller"), habiendo recibido el dinero de parte suya, no lo envia dentro de un plazo de diez (10) dias a partir de la fecha de su recepcion o no da instrucciones para destinar una cantidad de dinero equivalente a la persona designada por usted, dentro de los 10 dias a partir de la fecha en que reciba los fondos de parte suya, a menos que usted indique lo contrario. Si sus instrucciones respecto a cuando se deberan de enviar o transmitir los fondos no son acatadas y el dinero no se envia o transmite dentro del plazo mencionado, usted tendra derecho a la devolucion de su dinero. Para obtener la devolucion, usted debera de entregar o enviar por correo su solicitud por escrito a nuestro agente de ventas autorizado, cuyo nombre y direccion aparecen descritos en su recibo de cliente o a UniTeller, en la direccion: UniTeller at 218 Route 17 North-Suite 402, Rochelle Park, NJ 07662. Si usted no recibe su reembolso, podra tener derecho a la devolucion de su dinero, mas el pago de una multa de hasta $1,000.00 dolares y de los honorarios del abogado, de acuerdo con la Seccion 2102 del Codigo Financiero de California. </font><font style="font-size:9px;"><u><b>POLITICA DE PRIVACIDAD:</b></u> UniTeller no revela ni vende la informacion personal de usted a terceras partes que no son filiales, excepto (i) conforme lo exija la ley, (ii) a agencias gubernamentales, (iii) a entidades que procesan o pagan las transacciones o proveen otros servicios o productos a UniTeller, o (iv) cuando UniTeller lo considera necesario o adecuado para prestarle servicio a usted. </font><font style="font-size:8px;"><u><b>TERMINOS:</b></u> Ademas del costo de la transferencia aplicable a esta transaccion, el tipo de cambio a moneda nacional sera aplicado. Cualquier diferencia entre la tarifa ofrecida a los clientes y la tarifa recibida por UniTeller sera conservada por UniTeller. UniTeller no asume responsabilidad alguna, bajo ninguna circunstancia, si el numero de cuenta no es correcto para abonos en cuenta bancaria. </font>
</div>
</td>
</tr>
<tr height="10">
<td colspan="3" height="5" align="LEFT" valign="BOTTOM" width="622">
</td>
</tr>
<tr border="1" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
<td colspan="3" align="LEFT" valign="BOTTOM" width="622" style="bottom" class="dashedtop">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td align="CENTER" valign="BOTTOM" style="bottom">
--CUT HERE--
</td>
<td align="CENTER" valign="BOTTOM" style="bottom">
<b>AGENT COPY (COPIA DEL AGENTE)</b>
</td>
<td align="CENTER" valign="BOTTOM" style="bottom">
--CUT HERE--
</td>
</tr>
</tbody></table>
</td>
</tr>
<!-- SECOND PART ROW -->
<tr height="57">
<td align="CENTER" class="lefttop right">
<img height="43" width="175" border="0" src="./UNITELLER_RECEIPT_LOGO.JPEG"><br>
<font style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
<b>
Tel:1-800-495-5674
/
Fax:1-866-235-3279
</b>
</font>
</td>
<td class="top" valign="TOP">
<table width="230" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="30">
<td width="80" align="RIGHT" valign="MIDDLE" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
SERVICE TYPE <br>&nbsp;(TIPO DE SERVICIO)
</td>
<td width="150" valign="MIDDLE" style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>&nbsp;LRC-CTA BANORTE</b>
</td>
</tr>
<tr height="18">
<td width="80" align="RIGHT" valign="TOP" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
PRICE CHOICE <br>&nbsp;(TIPO DE PRECIO)
</td>
<td width="150" valign="TOP" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
&nbsp;REGULAR
</td>
</tr>
</tbody></table>
</td>
<td class="lefttop right">
<table width="230" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td width="80" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
DATE (FECHA)
</td>
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<div align="RIGHT">
Tue 08/Nov/2016 03:20:30 AM EST
</div>
</td>
</tr>
<tr height="40">
<td width="80" valign="BOTTOM" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
<div align="left">
TRANSACTION NO <br>&nbsp;(NO DE TRANSACCION)
</div>
</td>
<td align="right" valign="BOTTOM" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b><font size="3">67094422222</font></b>
</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td width="202" class="box" align="center" valign="TOP">
<table width="200" height="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="70">
<td class="bottom" valign="MIDDLE">
<div align="center" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
AUTHORIZED SERVICIO UNITELLER AGENT<br>
(AGENTE AUTORIZADO DE SERVICIO UNITELLER )
</div>
<div align="center" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<b>Xoom Corporation</b><br>
<font style="font-size:7px; font-family:Arial, Verdana, Sans-serif"> <b>San Francisco, CALIFORNIA</b> </font>
</div>
<div align="center" style="font-size:10px; font-family:Arial, Verdana, Sans-serif">
<strong>PHONE &nbsp;(TEL): </strong><b>8778151531, 4152814290</b>
</div>
</td>
</tr>
<tr height="50">
<td valign="MIDDLE">
</td>
</tr>
</tbody></table>
</td>
<td width="230" align="left" class="top bottom">
<table border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td width="230" valign="BOTTOM" colspan="2" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
REMITTER INFORMATION (INFORMACION DEL REMITENTE)
</td>
</tr>
<tr>
<td width="10">&nbsp;
</td>
<td width="220">
<font style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>kapilrrraj verma</b><br>
</font>
<font style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b>PHONE &nbsp;(TEL): </b>9956852140<br>
1543 N 67TH<br>
Dwarka,
CALIFORNIA,
90047,
USA</font>
</td>
</tr>
<tr>
<td colspan="2" height="5">
</td>
</tr>
<tr>
<td width="230" valign="BOTTOM" colspan="2" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
BENEFICIARY INFOMATION (INFORMACION DEL BENEFICIARIO)
</td>
</tr>
<tr>
<td width="10">&nbsp;
</td>
<td width="220">
<font style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
<b>vikyy kumar rawat sharma</b><br>
</font>
<font style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
PHONE &nbsp;(TEL):
2323445456<br>
D-1 New Delhi<br>
DELHI,
BAJA CALIFORNIA NORTE,
12323,
MEXICO</font>
</td>
</tr>
</tbody></table>
</td>
<td width="230" align="left" valign="BOTTOM" class="box">
<table width="230" height="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr height="18">
<td width="100" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;TRANSFER AMOUNT <br>&nbsp;(CANTIDAD DE ENVIO)
</td>
<td width="95" align="right" style="font-size:11px; font-family:Arial, Verdana, Sans-serif">
$ 1.00
</td>
<td width="35" align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
USD
</td>
</tr>
<tr height="18">
<td style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;TRANSFER FEE <br>&nbsp;(CARGOS POR ENVIO)
</td>
<td style="font-size:11px; font-family:Arial, Verdana, Sans-serif" align="right">
+ 1.900</td>
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif" align="CENTER">
USD
</td>
</tr>
<tr height="23">
<td style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
&nbsp;<b>TOTAL&nbsp;(TOTAL)</b>
</td>
<td class="top2" align="right" style="font-size:14px; font-family:Arial, Verdana, Sans-serif">
<b>$ 2.90</b>
</td>
<td class="top2" align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
USD
</td>
</tr>
<tr height="23">
<td valign="MIDDLE" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;EXCHANGE RATE <br>&nbsp;(TASA DE CAMBIO)
</td>
<td align="CENTER" colspan="2" style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
USD $ 1.00 = 12.0000&nbsp;MXN
</td>
</tr>
<tr height="23">
<td style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
&nbsp;<b>TOTAL TO RECIPIENT <br>&nbsp;(TOTAL AL DESTINATARIO)</b>
</td>
<td align="right" style="font-size:14px; font-family:Arial, Verdana, Sans-serif">
<b>12.00</b>
</td>
<td align="CENTER" style="font-size:8px; font-family:Arial, Verdana, Sans-serif">
<b>MXN</b>
</td>
</tr>
<tr>
<td width="80" style="font-size:7px; font-family:Arial, Verdana, Sans-serif">
DATE AVAILABLE <br>&nbsp;(FECHA DISPONIBLE)
</td>
<td colspan="2" style="font-size:9px; font-family:Arial, Verdana, Sans-serif">
<div align="RIGHT">
Tue 08/Nov/2016 <b>*</b>
</div>
</td>
</tr>
</tbody></table>
</td>
</tr>
<!-- SIGNATURES -->
<tr height="30" class="box">
<td colspan="3" width="660" height="30" valign="BOTTOM" style=" font-size:7px; font-family:Arial, Verdana, Sans-serif;">
<table width="662" cellspacing="0" cellpadding="0">
<tbody><tr>
<td width="330" align="CENTER">
<br>_______________________________________________<br>
SIGNATURE OF REMITTER (FIRMA DEL REMITENTE)
</td>
<td width="330" align="CENTER">
<br>___________________________________________<br>
SIGNATURE OF AGENT (FIRMA DEL AGENTE)
</td>
</tr>
</tbody></table>
</td>
</tr>
</tbody></table>
<!-- Start Minireceipt -->
</form>
</body></html>
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