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Details
| Name | [A. Name] | Status | [Allocated] |
|---|---|---|---|
| Nominee Name | [Nominee Name] | Outstanding Amount | [US Dollar] [Amount] |
| Amount | [US Dollar] [Amount] | Case Type | [Benefit Sample] |
| Foreign Currency | [Foreign Currency] | Delivery Method | [Cash] |
| Cover Period From | [Date] | Cover Period To | [Date] |
| Effective Date | [Date] | Type | [Type Description] |
| Instrument Generated | [True] |