Declaration
I declare that the original cash memo / encashment certificate issued in connection with the above transaction is unavailable because:
It has been lost.It has been misplaced.It was damaged or destroyed.It was retained by another authorised person / authority.It is currently inaccessible.Other:
I request the company to:
Process surrender of the unused foreign exchange.Provide a duplicate transaction document.Confirm details of the original transaction.Other:
I further declare that:
- I have not transferred, pledged or otherwise misused the original document.
- I have not used the same foreign exchange or document for any duplicate claim or transaction.
- I undertake to return the original document if it is subsequently found.
- I accept responsibility for any duplicate use or incorrect representation.
- The company may mark any duplicate document as “Duplicate Issued on Customer Declaration”.
For Office Use
Original transaction traced in records:YesNo
Transaction details matched:YesNo
Duplicate document issued:YesNo