Created By: Created Date:

Approved By: Approved Date:

Paid By: Paid Date:

Cancel Requested By: Cancel Requested Date:

Cancel Approved By: Cancel Approved Date:

Verified By: Verified Date:

Created From:

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Name:
CustomerId:
JME A/C No.:
Address:
Country:		DOB:
Contact No:
Id No:		Id Type:
Native Country:		Occuapation:
Email:
Ext Customer ID:
Membership Id:

Name:
Address:
Country:
Mobile No:
Id Type:		Id No:
Relationship with sender:
Membership Id:

Purpose:
Source of Fund:

BENIFICIARY NAME AS PER BANK:

Agent:
Branch:
S. Agent Location:
District:
City:
Country:
Referral Name:

Agent:
Branch:
Payout Location:
Payer:
District:
City:
Country:

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Payout Country:
Payout Mode:	View Details
Mode of Payment:
Collected Amount:
Service Charge:
Reward Points:
Send Agent Commission:
Sent Amount:
Exchange Rate
Rate Margin
Payout Amount:
Pay Agent Comm.:

Mode of Deposit:
Trust Pay Id:
Pay Status:
Introducer:
Customer Signature:
Account Number:
Bank Name:
Branch Name:
Posted Date:
Release Date:

S. No.	Voucher No.	Voucher Date	Voucher Amt.	Bank Name.
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