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Adden No:

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CN Number:

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Client Name

Bank Name

Amount

Extra

Currency

Rate

Amount:

MR No

MR Date

MOP

Bank Name

Branch

Cheque / Payorder No

Cheque/Payorder Date

Clause

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Bank Name

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Producer ID

Risk Option

Marine(%)

War & Srcc

Premium

Vat

%

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Stamp Duty

%

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Grand Total