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Created By: Created Date: Approved By: Approved Date: Paid By: Paid Date: Cancel Requested By: Cancel Requested Date: Cancel Approved By: Cancel Approved Date:
Sender Name: Address: Country: City/State: Mobile No: Tel. No: : ID Validity Date: Email: Native Country: Membership Id:	Receiver Name: Address: Country: City/State: Mobile No: Tel. No: : ID Validity Date: Relationship with Sender: Membership Id:
Sending Agent Agent: Branch: Address: Country:	Receiving Agent Agent: Branch: Address: Country:
Payout Amount Collection Amount: Service Charge: Send Agent Commission: Pay Agent Comm.: Customer Rate Settlement Rate Sent Amount: Payout Amount:	Transaction Information Mode of Payment: Txn. Status:  - Account Number: Bank: Branch: Source of Fund: Reason For Remittance: Transaction Message:
Deposit Information