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Date of Issue pol soi
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Personal losses:
Property losses:
Total: €Bam- 2 Date Cheque to be Issued +
(Uiless further communieation is received in writing from
the abpve named
‘Tots! Amount in Wards:_£ Fatal i.
1 accept this amount without adm
Insurance have advised me that I ia
Signed:
Witnessed:
Print Name: ChLiain€ Ge or
{ acknowledge that I have been given ten (18) husiness days in which to reconsider my acceptance of
this offer but Lam waiving my right to this cooling off period
‘Signed: Finn Me Dem Es ae 2/67
PAYMENT AUTHORISATION
Please issue cheque as per above agreement
Claim Rep BV DOSEN 1/521 Mele. S_ eamerbanry
Signed: Ci m Qo Date: a» |e i>
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