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A–30—Model form for pre-payment disclosures for remittance transfers exchanged into local currency (§ 205.31(b)(1)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 NOT A RECEIPT Transfer Amount: Transfer Fees and Taxes: Total: Exchange Rate: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Transfer Amount: Other Fees and Taxes: Total to Recipient: 1,227.00 MXN -40.00 MXN 1,187.00 MXN A–31—Model form for receipts for remittance transfers exchanged into local currency (§ 205.31(b)(2)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 RECEIPT SENDER: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 222-555-1212 RECIPIENT: Carlos Gomez 123 Calle XXX Mexico City Mexico PICK-UP LOCATION: ABC Company 65 Avenida YYY Mexico City Mexico Confirmation Code: ABC 123 DEF 456 Date Available: 3/04/2011 Transfer Amount: Transfer Fees and Taxes: Total: Exchange Rate: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Transfer Amount: Other Fees and Taxes: Total to Recipient: 1,227.00 MXN -40.00 MXN 1,187.00 MXN Problems or questions? Contact us within 180 days at 800-123-4567 or www.abccompany.com. You can contact us for a written explanation of your rights. You can cancel for a full refund within 1 business day of payment, unless the funds have been picked up/deposited. For questions or complaints about ABC Company, contact: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–32—Model form for combined disclosures for remittance transfers exchanged into local currency (§ 205.31(b)(3)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 SENDER: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 222-555-1212 RECIPIENT: Carlos Gomez 123 Calle XXX Mexico City Mexico PICK-UP LOCATION: ABC Company 65 Avenida YYY Mexico City Mexico Confirmation Code: ABC 123 DEF 456 Date Available: 3/04/2011 Transfer Amount: Transfer Fees and Taxes: Total: Exchange Rate: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Transfer Amount: Other Fees and Taxes: Total to Recipient: 1,227.00 MXN -40.00 MXN 1,187.00 MXN Problems or questions? Contact us within 180 days at 800-123-4567 or www.abccompany.com. You can contact us for a written explanation of your rights. You can cancel for a full refund within 1 business day of payment, unless the funds have been picked up/deposited. For questions or complaints about ABC Company, contact: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–33—Model form for pre-payment disclosures for dollar-to-dollar remittance transfers (§ 205.31(b)(1)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 NOT A RECEIPT Transfer Amount: Transfer Fees and Taxes: Total: $100.00 $10.00 $110.00 Transfer Amount: Other Fees and Taxes: Total to Recipient: $100.00 -$5.00 $95.00 A–34—Model form for receipts for dollar-to-dollar remittance transfers (§ 205.31(b)(2)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 RECEIPT SENDER: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 301-555-1212 RECIPIENT: Carlos Gomez 106 Calle XXX Mexico City Mexico PICK-UP LOCATION: ABC Company 65 Avenida YYY Mexico City Mexico Confirmation Code: ABC 123 DEF 456 Date Available: 3/04/2011 Transfer Amount: Transfer Fees and Taxes: Total: $100.00 $10.00 $110.00 Transfer Amount: Other Fees and Taxes: Total to Recipient: $100.00 -$5.00 $95.00 Problems or questions? Contact us within 180 days at 800-123-4567 or www.abccompany.com. You can contact us for a written explanation of your rights. You can cancel for a full refund within 1 business day of payment, unless the funds have been picked up/deposited. For questions or complaints about ABC Company, contact: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–35—Model form for combined disclosures for dollar-to-dollar remittance transfers (§ 205.31(b)(3)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Today’s Date: 3/03/2011 SENDER: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 301-555-1212 RECIPIENT: Carlos Gomez 106 Calle XXX Mexico City Mexico PICK-UP LOCATION: ABC Company 65 Avenida YYY Mexico City Mexico Confirmation Code: ABC 123 DEF 456 Date Available: 3/04/2011 Transfer Amount: Transfer Fees and Taxes: Total: $100.00 $10.00 $110.00 Transfer Amount: Other Fees and Taxes: Total to Recipient: $100.00 -$5.00 $95.00 Problems or questions? Contact us within 180 days at 800-123-4567 or www.abccompany.com. You can contact us for a written explanation of your rights. You can cancel for a full refund within 1 business day of payment, unless the funds have been picked up/deposited. For questions or complaints about ABC Company, contact: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–36—Model form for error resolution and cancellation disclosures (long) (§ 205.31(b)(4)) What To Do If You Think There Has Been An Error or Problem: If you think there has been an error or problem with your remittance transfer: • Call us at [insert telephone number][; or] • Write us at [insert address][; or] • [E-mail us at [insert electronic mail address]. You must contact us within 180 days of the date we promised to you that funds would be made available to the recipient. When you do, please tell us: (1) Your name and address [or telephone number]; (2) The error or problem with the transfer, and why you believe it is an error or problem; (3) The name of the person receiving the funds, and if you know it, his or her telephone number or address; [and] (4) The dollar amount of the transfer; [and (5) The confirmation code or number of the transaction.] We will determine whether an error occurred within 90 days after you contact us and we will correct any error promptly. We will tell you the results within three business days after completing our investigation. If we decide that there was no error, we will send you a written explanation. You may ask for copies of any documents we used in our investigation. What To Do If You Want To Cancel A Remittance Transfer: You have the right to cancel a remittance transfer and obtain a refund of all funds paid to us, including any fees. In order to cancel, you must contact us at the [phone number or e-mail address] above within one business day of payment for the transfer. When you contact us, you must provide us with information to help us identify the transfer you wish to cancel, including the amount and location where the funds were sent. We will refund your money within three business days of your request to cancel a transfer as long as the funds have not already been picked up or deposited into a recipient’s account. A–37—Model form for error resolution and cancellation disclosures (short) (§ 205.31(b)(2)(vi)) Problems or questions? Contact us within 180 days at 800-123-4567 or www.abccompany.com. You can contact us for a written explanation of your rights. You can cancel for a full refund within 1 business day of payment, unless the funds have been picked up/deposited. For questions or complaints about ABC Company, contact: A–38—Model form for pre-payment disclosures—Spanish (§ 205.31(b)(1)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Fecha: 3/03/2011 NO ES UN RECIBO Cantidad de Envío: Tarifas e Impuestos: Total: Tasa de Cambio: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Cantidad de Envío: 1,227.00 MXN Otras Tarifas e Impuestos: -40.00 MXN Total a Destinatario: 1,187.00 MXN A–39—Model form for receipts—Spanish (§ 205.31(b)(2)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Fecha: 3/03/2011 RECIBO REMITENTE: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 222-555-1212 DESTINATARIO: Carlos Gomez 123 Calle XXX Mexico City Mexico RETIRAR EN: ABC Company 65 Avenida YYY Mexico City Mexico Código de Confirmación:ABC 123 DEF 456 Fecha Disponible: 3/04/2011 Cantidad de Envío: Tarifas e Impuestos: Total: Tasa de Cambio: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Cantidad de Envío: 1,227.00 MXN Otras Tarifas e Impuestos: -40.00 MXN Total a Destinatario: 1,187.00 MXN ¿Problemas o preguntas? Contáctenos dentro de 180 días a 800-123-4567 o www.abccompany.com. Puede contactarnos para una explicación escrita de sus derechos. Puede cancelar para un reembolso total dentro de un día hábil del pago, a no ser que los fundos han sido retirados o depositados. Para preguntas o presentar una queja en ABC Company, contacte a: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–40—Model form for combined disclosures—Spanish (§ 205.31(b)(3)) ABC Company 1000 XYZ Avenue Anytown, Anystate 12345 Fecha: 3/03/2011 REMITENTE: Pat Jones 100 Anywhere Street Anytown, Anywhere 54321 222-555-1212 DESTINATARIO: Carlos Gomez 123 Calle XXX Mexico City Mexico RETIRAR EN: ABC Company 65 Avenida YYY Mexico City Mexico Código de Confirmación:ABC 123 DEF 456 Fecha Disponible: 3/04/2011 Cantidad de Envío: Tarifas e Impuestos: Total: Tasa de Cambio: $100.00 $10.00 $110.00 US$1.00 = 12.27 MXN Cantidad de Envío: 1,227.00 MXN Otras Tarifas e Impuestos: -40.00 MXN Total a Destinatario: 1,187.00 MXN ¿Problemas o preguntas? Contáctenos dentro de 180 días a 800-123-4567 o www.abccompany.com. Puede contactarnos para una explicación escrita de sus derechos. Puede cancelar para un reembolso total dentro de un día hábil del pago, a no ser que los fundos han sido retirados o depositados. Para preguntas o presentar una queja en ABC Company, contacte a: State Regulatory Agency 800-111-2222 www.stateregulatoryagency.com Consumer Financial Protection Bureau 800-555-9999 www.consumerfinance.gov A–41—Model form for error resolution and cancellation disclosures (long) —Spanish (§ 205.31(b)(4)) Lo Que Usted Debe Hacer Si Cree Que Haya Un Error O Problema: Si cree que haya un error o problema con su envío de dinero: • Llámenos a [inserte número de teléfono][; o] • Escribanos a [inserte dirección][; o] • [Mándenos un e-mail a [inserte dirección de correo electrónico]. Debe contactarnos dentro de 180 días de la fecha que se le prometió que los fundos estarían disponibles al destinatario. Cuando se comunique con nosotros, por favor provee la siguiente información: (1) Su nombre y dirección [o número de teléfono]; (2) El error o problema con su envío de dinero, y porque cree que haya un error o problema; (3) El nombre del destinatario, y si lo sabe, su número de teléfono o dirección; [y] (4) El monto a enviar en dólares; [y (5) El código de confirmación o el número de la transacción.] Nosotros determinaremos si haya un error dentro de 90 días después de usted nos contacta y corrigiéremos el error rápidamente. Le diremos los resultados dentro de tres días hábiles después de terminar nuestra investigación. Si decidimos que no había un error, le mandaremos a usted una explicación escrita. Puede pedir copias de los documentos que usamos en nuestra investigación. Lo Que Usted Debe Hacer Si Quiere Cancelar Un Envío De Dinero: Tiene el derecho de cancelar un envío de dinero y obtener un reembolso de todo el dinero, incluyendo tarifas o gastos que usted nos pagó. Para cancelar, debe contactarnos al [número de teléfono o dirección de correo electrónico] que se encuentra arriba dentro de un día hábil del pago para el envío de dinero. Cuando nos contacte, debe proveernos con información que nos ayudará a identificar el envío de dinero que quiere cancelar, inclusivo la cantidad del envió y el lugar donde fue enviado. Le reembolsamos su dinero dentro de tres días hábiles de su petición de cancelar a no ser que los fundos han sido retirados o depositados en la cuenta del destinatario.