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− | <includeonly>{{{1}}}{|style="border-collapse:collapse; background:none; width:100%;" border={{#if:{{{Border|}}}|"1"|"0"}} | + | <includeonly>{{{1}}}{ |
− | |- style="height:3pt" | + | |style="border-collapse:collapse; background:none; width:100%;" border={{#if:{{{Border|}}}|"1"|"0"}} |
− | |nowrap rowspan="2"|<p style="margin:0pt 0pt 0pt 0pt;">{{{2}}} </p> | + | |- style="height:3pt"|nowrap rowspan="2"| |
− | | <p style="font-size:1pt; margin:0pt 0pt 0pt 0pt;"> </p> | + | <p style="margin:0pt 0pt 0pt 0pt;">{{{2}}} </p> |
− | | nowrap rowspan="2" align="right"|<p style="margin:0pt 0pt 0pt 0pt;"> {{#if:{{{RawN| }}}|{{{3}}}|'''({{{3}}})'''}}</p> | + | | |
+ | <p style="font-size:1pt; margin:0pt 0pt 0pt 0pt;"> </p> | ||
+ | | nowrap rowspan="2" align="right" | ||
+ | | | ||
+ | <p style="margin:0pt 0pt 0pt 0pt;"> {{#if:{{{RawN|}}}|{{{3}}}|'''({{{3}}})'''}}</p> | ||
|- style="height:2pt" | |- style="height:2pt" | ||
− | | style="border-top:{{{LnSty|3px dotted #e5e5e5}}}; width:99%;"|<p style="font-size:1pt; margin:0pt 0pt 0pt 0pt;"> </p> | + | | style="border-top:{{{LnSty|3px dotted #e5e5e5}}}; width:99%;" |
+ | | | ||
+ | <p style="font-size:1pt; margin:0pt 0pt 0pt 0pt;"> </p> | ||
|}</includeonly><noinclude> | |}</includeonly><noinclude> |