BANK DETAILS FORM
* Booking Reference ::
*Complete Address :
*Bank and Branch Name :
Complete Address :
(optional if bank is located in the Philippines)
*Account Name (name of beneficiary) :
*Account Number :
*Account Currency :
(Below details are required for international remittance only)
ABA No. :
Swift Code :
IBAN No. :
Sort Code :
Routing No. :
(If applicable)
Intermediary Bank Name
:
Address :
SWIFT code :
To be signed by Authorized Signatories
*Required details.
PLEASE TYPE THE DETAILS IN CAPITAL LETTERS
WRITE "N/A" IF NOT APPLICABLE
ACKNOWLEDGEMENT, RELEASE, WAIVER AND QUITCLAIM
In connection with the refund of Booking Reference ___________ (the “Booking”), with details:
Name of passenger(s):
Issued on:
Flight Details:
I _____________________________________________________ received from Cebu Air,
Inc. (“CEBU”) the amount of _________________________ (the “Refund”), and hereby release and
discharge CEBU, its subsidiaries, officers, and employees from any action of whatever nature, arising
from or in connection with the Booking.
(For group booking: I am authorized by all the other passengers in this Booking to claim and receive the
proceeds of the Refund.)
I execute this Instrument willingly, voluntarily and in good faith, and acknowledge that this Refund is the
full and final settlement of any and all claims which I/we may have against CEBU that may be pleaded as
an absolute and final bar to any and all suits, claims or legal action that may be brought against CEBU by
virtue of the Booking.
__________________
Date
___________________________
Requestor’s Signature
Requestor’s Name:
Address:
Contact Number:
Email Address:
