Remittance Advice

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Indian Oil and Gas Canada

Company Name

Date prepared (DD-MMM-YYYY)

Address

Contact Person

Telephone no.

Company ID

Cheque Amount

Bank deposit date (DD-MMM-YYYY)

Date received (DD-MMM-YYYY)

Reserve Name

Royalty Payments

Date received (DD-MMM-YYYY) Royalty entity ID Amount due Date (YYYY-MMM) Royalty entity ID Amount due
           
           
           
           
           
           
           
           
           
           
           

Total

132-004 (5-96)

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