Appendix 7
Radio log-book
Part I
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border-collapse:collapse"><tbody><tr><td colspan="2" style="width:171.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:6pt; margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Name of ship/vessel</span></p></td><td style="width:109.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:6pt; margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">IMO/Official number and international call sign</span></p></td><td colspan="2" style="width:96.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Home Port</span></p></td><td style="width:73.65pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Gross tonnage</span></p></td></tr><tr><td colspan="2" style="width:171.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:12pt; text-align:center; font-size:16pt"><span style="font-weight:bold"></span></p></td><td style="width:109.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:12pt; text-align:center; font-size:16pt"><span style="font-weight:bold"></span></p></td><td colspan="2" style="width:96.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:12pt; text-align:center; font-size:16pt"><span style="font-weight:bold"></span></p></td><td style="width:73.65pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:12pt; text-align:center; font-size:16pt"><span style="font-weight:bold"></span></p></td></tr><tr><td style="width:130.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:6pt; margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Port at which, and date when, voyage commenced</span></p></td><td colspan="3" style="width:216pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Nature of the voyage or employment</span></p></td><td colspan="2" style="width:116.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:6pt; margin-left:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Port at which, and date when, voyage terminated</span></p></td></tr><tr><td style="width:130.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:0pt; margin-left:0pt; font-size:10pt"><span style="font-family:'Bookman Old Style', serif">Port</span></p></td><td colspan="3" rowspan="2" style="width:216pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-left:0pt; margin-bottom:12pt; text-align:center; font-size:16pt"><span style="font-weight:bold"></span></p></td><td colspan="2" style="width:116.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:0pt; margin-left:0pt; margin-bottom:12pt; font-size:10pt"><span>Port</span></p></td></tr><tr><td style="width:130.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:0pt; margin-left:0pt; margin-bottom:12pt; font-size:10pt"><span>Date</span></p></td><td colspan="2" style="width:116.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="NormalIndent" style="margin-top:0pt; margin-left:0pt; margin-bottom:12pt; font-size:10pt"><span>Date</span></p></td></tr><tr style="height:0pt"><td style="width:141.75pt"></td><td style="width:40.85pt"></td><td style="width:120.75pt"></td><td style="width:65.2pt"></td><td style="width:42.55pt"></td><td style="width:84.45pt"></td></tr></tbody></table>
Serial number ________________________ from _____________________________ to _________________________
Delivered/posted to the Manager, Ship Operations and Qualifications, Canberra, on ……… / ……… / ………..
Date
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border-collapse:collapse"><tbody><tr><td style="width:37.15pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Master</span></p></td><td style="width:238.15pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'CG Times (W1)', serif">…………………………………………………………….</span></p></td></tr><tr><td style="width:37.15pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Address</span></p></td><td style="width:238.15pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'CG Times (W1)', serif">…………………………………………………………….</span></p></td></tr><tr><td colspan="2" style="width:286.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">………………………………………………………………….……..</span></p><p style="font-size:10pt"><span style="font-family:'CG Times (W1)', serif">……………………………………………………………………..…..</span></p></td></tr></tbody></table>
SECTION A — PARTICULARS OF SHIP/VESSEL
<table cellspacing="0" cellpadding="0" style="width:496.9pt; margin-top:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td style="width:250.65pt; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Name</span></p></td><td style="width:138.55pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">IMO No./Official No.</span></p></td><td style="width:74.55pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Gross tonnage</span></p></td></tr><tr><td style="width:250.65pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Port of Registry</span></p></td><td style="width:138.55pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">International Call Sign</span></p></td><td style="width:74.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">MMSI</span></p></td></tr><tr><td style="width:250.65pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Sea area(s) in which ship/vessel is certified to operate</span></p></td><td colspan="2" style="width:223.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Date keel was laid</span></p></td></tr><tr><td colspan="3" style="width:485.35pt; border-top:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:18pt; font-size:10pt"><span style="font-family:'CG Times (W1)', serif">Expiry date of current Safety Radio Certificate</span></p></td></tr></tbody></table>
Method(s) used to ensure availability of radio facilities
| Duplication of equipment | No | | Yes | |
|---|
| At-sea maintenance capability | No | | Yes | |
| Shore based maintenance | No | | Yes | |
| | | | ↓ |
Details of service company
Name and address of Owner, Managing Owner or Agent
SECTION B — QUALIFIED PERSONNEL
Details of the qualified personnel on board
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border-collapse:collapse"><tbody><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:18pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Name</span></p></td><td colspan="2" style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Dates on board or dates of attachment</span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Class and number of cert</span><span style="font-family:'CG Times (W1)', serif; font-style:italic">ificate(s)</span><br><span style="font-family:'CG Times (W1)', serif; font-style:italic">and date(s) of issue</span></p></td></tr><tr><td style="width:154.55pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">From</span></p></td><td style="width:71.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">To</span></p></td><td style="width:154.55pt; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:154.55pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:71.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:154.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr></tbody></table>
Name and rank or muster number of designated person(s) with responsibility for radio communications during emergencies (as required by 3.2.2 of Appendix 2 to Marine Orders, Part 28)
Name of person(s) nominated to carry out appropriate tests and checks and Log entries (if different from above)
SECTION C — GMDSS RADIO LOG
| Date and time UTC | Station from | Station to | Operator’s actions or remarks | Frequency, channel or satellite |
|---|
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
SECTION D EQUIPMENT TESTS AND RESERVE ENERGY CHECKS
Annex 1 — Particulars of Batteries on Board
| Battery number | Number of cells | Manufacturer | Type of battery | Date supplied | Voltage & ampere hour capacity | Purpose for which used |
|---|
| | | | | | |
| | | | | | |
| | | | | | |
Annex 2 Monthly Report of Batteries
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td style="width:38.8pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td><td style="width:79.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Battery Number</span></p></td><td colspan="2" style="width:159.3pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:1pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Specific gravity as measured</span></p></td><td style="width:173.45pt; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic"></span></p></td></tr><tr><td style="width:38.8pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Date</span></p></td><td style="width:79.7pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">and cell number</span></p></td><td style="width:74.25pt; border-top:1pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">Before charge</span></p></td><td style="width:74.25pt; border-top:1pt solid #000000; border-right:0.75pt solid #000000; border-bottom:1pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic">After charge</span></p></td><td style="width:173.45pt; border-bottom:1pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:0pt; margin-bottom:6pt; text-align:center; font-size:10pt"><span style="font-family:'CG Times (W1)', serif; font-style:italic; letter-spacing:-0.2pt">Remarks</span></p></td></tr><tr><td style="width:38.8pt; border-top:1pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:79.7pt; border-top:1pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-top:1pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-top:1pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:173.45pt; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td></tr><tr><td style="width:38.8pt; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:79.7pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:173.45pt; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td></tr><tr><td style="width:38.8pt; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:79.7pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:74.25pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td><td style="width:173.45pt; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span style="font-family:'CG Times (W1)', serif; font-weight:bold"></span></p></td></tr></tbody></table>
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