RER
RER
RER
II Appendix 18
Reevised January 1992 Reevised January 1992
PAYEE PAYEE
Name/Signature ______________________________________________ Name/Signature ______________________________________________
Address _____________________________________________________ Address _____________________________________________________
WITNESS WITNESS
Name/Signature ______________________________________________ Name/Signature ______________________________________________
Residence Cert. No. ___________________________________________ Residence Cert. No. ___________________________________________
Date of Issue _________________________________________________ Date of Issue _________________________________________________
Place of Issue ________________________________________________ Place of Issue ________________________________________________
DMP DMP