<P align=right>合同编号：__________</P>
<P> 甲方：__________公司（以下简称供方），由__________代表。<BR> 乙方：__________公司（以下简称购方），由__________代表。</P>
<P> 目录<BR> 第一条 合同标的<BR> 第二条 技术资料<BR> 第三条 供货条件－－包装和标记<BR> 第四条 设备质量<BR> 第五条 合同价格和支付条件<BR> 第六条 保证<BR> 第七条 不可抗力<BR> 第八条 仲裁<BR> 第九条 通知<BR> 第十条 语言<BR> 第十一条 其他条件<BR> 附件1 设备技术说明书</P>
<P> 甲方______（供方）与乙方________（购方）达成如下协议：</P>
<P> 第一条 合同标的<BR> 供方同意出售，购方同意购买__________________。（详见本合同附件1，该附件为本合同不可分割的一部分）。</P>
<P> 第二条 技术资料<BR> 供方应向购方提供设备使用及维修技术资料一份，购方负有对该技术资料保密之义务。</P>
<P> 第三条 供货条件－－包装和标记<BR> 供方应在设备全额信用证开立之后的________个月内用密封集装箱或其他包皮包装从________发运设备。<BR> 供方有权从任何对其方便的港口发运设备。<BR> 供方应把设备运至商定的独联体东海岸______________港。<BR> 自设备从船舷运抵独联体远东港口时起灭失和（或）损坏的风险由供方转移到购方。<BR> 供方承担设备运输的一切费用及运抵港口前的保险费。<BR> 设备从独联体港口继续运到安装地的一切费用由购方承担。<BR> 发货前________天内供方应向购方通知发运情况，明确交通工具的种类和名称、计划发运日期及其他有关信息。<BR> 购方应支付履行海关手续的所有费用和一切与设备运入独联体境内有关的开支。<BR> 设备和技术资料用密封集装箱或其他包皮装运并附具包装清单，标记使用英语刷写。<BR> 发货单证包：<BR> （1）发货帐单（三份）<BR> （2）海运提单<BR> （3）装箱单<BR> （4）保险单</P>
<P> 第四条 设备质量<BR> 按本合同所供设备的质量应符合生产厂家的技术条件。如生产厂家有保证书，应用保证书加以确认。</P>
<P> 第五条 合同价格和支付条件<BR> 所供设备的总额为__________美元（CIF价）。购方应在合同签订后的________天内开立以供方为受益人的不可撤销的保兑信用证。该信用证在开立时起的________天内有效。<BR> 开证行应为独联体外经银行或日本、南韩、西欧、美国、加拿大的某家银行。<BR> 一切与在开证行开立信用证有关的费用由购方承担，而一切与议付行收取信用证有关的费用由供方承担。<BR> 支付在向议付行提交下列单据后进行：<BR> （1）发货帐单（3份）<BR> （2）海运提单<BR> （3）装箱单<BR> （4）保险单</P>
<P> 第六条 保证<BR> 供方保证所供设备在投入使用日起的____个月内，但不超过发货日起的____月内正常工作。</P>
<P> 第七条 不可抗力<BR> 在发生不可抗力情况致使合同一方不能全部或部分履行本合同的义务时，按此种不可抗力情况存在的时间推迟履行合同义务。<BR> 不可抗力情况是指双方不能预见或预测的由于非常事件而出现的情况，即：影响履行所承担义务的火灾、风暴、地震和其他自然现象，以及战争、任何性质的军事行动，各国政府的封锁与制裁等。<BR> 因不可抗力情况而不能履行义务的一方，应在不可抗力情况发生和停止的20天内书面通知另一方关于其发生和停止的情况。收信人所在国邮局在收到通知函日加盖的日期作为得悉该信息的日期。<BR> 协约双方国商会出具的证明书将成为证明上述情况发生及延续时间的必要证据。<BR> 如这些情况延续3个多月，每一方都有权拒绝继续履行本合同义务，同时任何一方都无权要求对方赔偿可能发生的损失。</P>
<P> 第八条 仲裁<BR> 所有可能由本合同而产生的纠纷或分歧均应由合同双方友好解决。<BR> 如果无法解决纠纷，则该纠纷应提交莫斯科市外贸仲裁委员会按其业务规章审理（提交一般法院审理者除外），该委员会的决定对于双方均为终审，必须执行。</P>
<P> 第九条 通知<BR> 一切通知等双方均应按本合同条件以书面形式进行。</P>
<P> 第十条 语言<BR> 本合同用俄语书就。供方提供英文的全部技术资料和供货单证。</P>
<P> 第十一条 其他条件<BR> 自本合同签署之日起，所有在此以前的有关谈判和往来信函均告失效。<BR> 对本合同的任何修改和补充只有在以书面形式形成并经双方有关全权代表签字后方能生效。经双方确认的往来信函、传真、电子邮件等，将作为本合同的组成部分，并有合同的效力。<BR> 任何一方都无权在未征得对方书面同意之前将自己对合同的权利和义务转让给第三者。<BR> 本合同于________年________在俄罗斯______签署。一式两份，两份具有同等效力。</P>
<P> </P>
<P align=right><BR>供方：__________________<BR>购方：__________________</P>
<P><BR> 附件1<BR> 本附件为____和______于________签订的第______号购货合同不可分割的一部分。<BR> 按照合同规定的条件，______供应下列设备：<BR></P>
<P>
<TABLE style='BORDER-RIGHT: medium none; BORDER-TOP: medium none; BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: collapse; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt' cellSpacing=0 cellPadding=0 border=1>
<TR>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 61.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>顺序</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>号码</P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 73.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=97>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>商品（设备）</P>
<P class=msoplaintext>名称</P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 63pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=84>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>计量</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>单位</P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 54pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=72>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>单位</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 56.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=75>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>数量</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>每批</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>价格</P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>货币</P>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center>名称</P></TD></TR>
<TR>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 61.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>1</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 73.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=97>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>2</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 63pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=84>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>3</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 54pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=72>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>4</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 56.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=75>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>5</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>6</SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center><SPAN lang=en-us>7</SPAN></P></TD></TR>
<TR>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 61.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 73.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=97>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 63pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=84>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 54pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=72>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 56.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=75>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD></TR>
<TR>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 61.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 73.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=97>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 63pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=84>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 54pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=72>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 56.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=75>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD></TR>
<TR>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 61.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 73.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=97>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 63pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=84>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 54pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=72>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 56.1pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=75>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD>
<TD style='BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; WIDTH: 61.55pt; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt' width=82>
<P class=msoplaintext style='TEXT-ALIGN: center' align=center> <SPAN lang=en-us></SPAN></P></TD></TR></TABLE></P></div></div>