WE HEREBY DECLARE THAT THE INFORMATION PROVIDED IN THIS DOCUMENT ARE CORRECT & UNDERTAKE TO PAY ALL FEES & CHARGES AS APPLICABLE.
AGENT NAME:
{{ $form_data[0]->agent_name }}
COMPANY NAME:
{{$company}}
DATE:
{{ $form_data[0]->created_at->format('Y/m/d') }}
TIME:
{{ $form_data[0]->created_at->format('h:i a') }}