Two Point Punch
Inside the Punch tab, navigate to the ‘Two Point Punch’ icon.
When you switch to this mode, the Tools mounted in the turret window appear, and you can pick the tool to use.

After picking the tool, you can use the right mouse button to pick the edge of the tool to use for punching. Then, click to set the start point of the punch. Now, when you move the mouse, MetaCAM checks if the punch is feasible between the two points you have selected. The punching is feasible if the angle between the two points is the same as the angle of the tool edge you have selected, or if the tool is mounted in an indexing station. If the punching is feasible, you can see the outline of the punch as you drag the mouse, and when you click again the punch is created.

If you are holding the tool by its centre (and not any of the edges), you can punch at any angle with any tool, even if it is not mounted in an indexing station.
Working with a tool that already exists in the drawing
To work with a tool that already exists in the part, just select any random tool from the Tools mounted in the turret window. Then, hold down the ALT key and click on some punch tooling in the part; the tool used by that punch will be picked up for use.