Payment Confirmation – Countrywide Visas

CRM form to confirm a client’s payment. Upon submission, details will be sent to Accounts and Management for verification and invoice generation.

1) CRM & Office Details

CRM Name *CRM Email *CRM Contact No. *Branch *Employee IDClient ID / Case No. (optional)

2) Client Details

Client Full Name *Client Email *Client Phone *Preferred Country *

Client Address *

Visa Category *Service Package

3) Payment Information

Amount Paid (₹) *Payment Date *Pending Amount

Pending Amount Due DateDiscount (₹)

Payment Purpose *Payment Mode *

Transaction / UTR / UPI Ref *Channel / AppPaid From BankPaid To

4) Proof of Payment (Combined Max 4MB)

Upload Proof *Ensure ID, Date & Time are visible.Additional Proof

Internal Notes (optional)

5) Declaration

I, the undersigned CRM, confirm that the above details represent a genuine client payment for services rendered by Countrywide Immigration Pvt. Ltd.
Please verify and generate the invoice accordingly.

CRM E-Sign (type full name) *E-Sign Date *