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| Received Date |
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| Amount | Sporting Expense Type | ||||||
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| Start Date |
| End Date |
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Comments
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Related Parent Evidence
Please select which one of these potential parents relates to this evidence:
| Select Row | Status | Type | Name | Effective Date | Details | |
|---|---|---|---|---|---|---|
| [mapped-image] | [Active] | [Sickness Benefit Evidence] | [Value] | [Date] | [Summary] |