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        <tr>
                <td class="gt" valign="top" colspan="2" nowrap="nowrap"><input type="checkbox" disabled="disabled"<!--#if expr="<X-FC-FIELD 1227 DEFAULT=PROP.85 NUMBER>"--> checked="checked"<!--#endif-->/>&nbsp;<X-FC-FIELD FORM.1227.9 STRING></td>
                <td class="gt" valign="top"><X-FC-FIELD FORM.1057.9 STRING></td>
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        <tr>
                <td class="gt" valign="top" colspan="2" nowrap="nowrap"><input type="checkbox" disabled="disabled"<!--#if expr="<X-FC-FIELD 1205 DEFAULT=PROP.85 NUMBER>"--> checked="checked"<!--#endif-->/>&nbsp;<X-FC-FIELD FORM.1205.9 STRING></td>
                <td class="gt" valign="top"><X-FC-FIELD FORM.1058.9 STRING></td>
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        <tr>
                <td class="gt" valign="top" colspan="2" nowrap="nowrap"><input type="checkbox" disabled="disabled"<!--#if expr="<X-FC-FIELD 1215 DEFAULT=PROP.85 NUMBER>"--> checked="checked"<!--#endif-->/>&nbsp;<X-FC-FIELD FORM.1215.9 STRING></td>
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        <tr>
                <td class="gt" valign="top" colspan="2" nowrap="nowrap"><input type="checkbox" disabled="disabled"<!--#if expr="<X-FC-FIELD 1216 DEFAULT=PROP.85 NUMBER>"--> checked="checked"<!--#endif-->/>&nbsp;<X-FC-FIELD FORM.1216.9 STRING></td>
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                <td class="gt" valign="top" colspan="2" nowrap="nowrap"><input type="checkbox" disabled="disabled"<!--#if expr="<X-FC-FIELD 1235 DEFAULT=PROP.85 NUMBER>"--> checked="checked"<!--#endif-->/>&nbsp;<X-FC-FIELD FORM.1235.9 STRING></td>
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        <tr>
                <td class="gt" align="right" valign="top" nowrap="nowrap"><X-FC-FIELD FORM.1003.9 STRING></td>
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        <td></td>
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        <tr>
                <td class="gtb" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1064.9 STRING></td>
                <td class="gtu" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1019.9 STRING></td>
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        <tr>
                <td class="gt" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1001.9 STRING></td>
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                <td class="p" align="right" nowrap="nowrap"><X-FC-FIELD 1229 DEFAULT=PROP.9 NUMFIELD></td>
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        <tr>
                <td class="gt" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1012.9 STRING></td>
                <td class="p" align="right" nowrap="nowrap"><X-FC-FIELD 1233 DEFAULT=PROP.9 NUMFIELD></td>
                <td class="p" align="right" nowrap="nowrap"><X-FC-FIELD 1232 DEFAULT=PROP.9 NUMFIELD></td>
                <td class="p" align="right" nowrap="nowrap"><X-FC-FIELD 1234 DEFAULT=PROP.9 NUMFIELD></td>
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        <tr>
                <td class="gt" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1011.9 STRING></td>
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        <tr>
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        <tr>
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<tr>
        <td></td>
        <td><table cellpadding="2" cellspacing="0" border="0" summary="">
        <tr>
                <td class="gtb" colspan="2" nowrap="nowrap"><X-FC-FIELD FORM.1072.9 STRING></td>
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                <td class="gt" align="right" nowrap="nowrap"><X-FC-FIELD FORM.1018.9 STRING></td>
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<tr>
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        <td class="secTitle" bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" nowrap="nowrap"><X-FC-FIELD FORM.5000.25 STRING></td>
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<tr>
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        <td class="gt" nowrap="nowrap"><X-FC-FIELD FORM.1091.9 STRING></td>
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                <td class="gt" align="right" valign="top" nowrap="nowrap"><X-FC-FIELD FORM.1068.9 STRING></td>
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