Periodic Payments Form (Original and Duplicates)

This form should be used as prescribed by the Exchange Control Guidelines.
This form should be completed in duplicate. Ensure that both the 'Original' and 'Duplicate' copies of the form are printed and completed.
Kindly note that the 'Duplicate' copy of the form is duplexed and should therefore bear information on both the front and back when printed.
The size of the printed form should be 8.5" x 11".

Sample:

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