To: [name and address of former superior or of his agent].
I [name and address of former vassal] opt to make the compensatory payment of £ [amount] due under the notice dated [date] by [number of instalments: see note for completion] equal half-yearly instalments of £ [amount] on 28 May and 28 November each year, commencing on [28 May or 28 November] [year].
I enclose payment of £ [amount]
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