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CERTIFICATE NO.

ISSUE BRANCH

ISSUED ON

CONSIGNMENT NO.

CN DATE

REASON

PACKAGES

BOOKING WEIGHT

PACKING TYPE

BOOKING FROM

BOOKING TO

GOODS

VOG

CONSIGNOR

CONSIGNEE

CLAIM AMOUNT

SETTLED AMT

SETTLED ON

PAYEE 1 NAME

PAYEE 1 AMOUNT

PAYEE 2 NAME

PAYEE 2 AMOUNT

REMARKS