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    I/We declare that the repair/damage to my/our vehicle with details above upon reporting the accident which occurred on or about the above date of loss and which was the subject of the above claim number has been carried out satisfactorily by the Workshop stated above and that I/We do not have any further claims against the company in respect of the said accident and that the payment of the repairer's bill shall constitute a full discharge of my/own claim for such a damage.

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