<table style="BORDER-COLLAPSE: collapse; MARGIN-LEFT: -27.3pt; BORDER-RIGHT: medium none" dir="rtl" border="1" cellpadding="0" cellspacing="0" width="595"> <tbody> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #b3b3b3; BORDER-TOP: window 3pt double; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; ; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> 30
</td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 1.5pt solid; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr> <tr> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 1cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: window 3pt double; PADDING-TOP: 0cm" width="38"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 120.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="161"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="76"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 70.9pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" valign="top" width="95"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 49.6pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="66"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.5pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 1.5pt solid; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 35.45pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="47"> </td> <td style="BORDER-BOTTOM: window 3pt double; BORDER-LEFT: window 3pt double; PADDING-BOTTOM: 0cm; PADDING-LEFT: 5.4pt; WIDTH: 42.55pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0cm" width="57"> </td></tr></tbody></table>