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SCHEDULE E-2/P-2
PERIOD : _______________________________________________________________________
AUTHORIZED DEALER : ___________________________________________________________
CURRENCY: _____________________________________________________________________
| Date Duplicate received | T-1 Form No. / Withdrawal From FC Account | Amount in currency | Code Numbers | ||||
| Million | Th. | Units | Country | Commodity | Department | ||
| Total | |||||||
Checked By: __________
Coded By: ____________
Stamp and Signature of Authorized Dealer
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