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SCHEDULE J/0-3

PERIOD : ________________________________________________________________

AUTHORIZED DEALER : ____________________________________________________

CURRENCY : _____________________________________________________________

Serial No. Form R/IRV Number/ Deposit in FC Account Amount Code Number
Million Th. Units Country Purpose
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total  

 

 

 

 

 

 

 

 

 

Checked By : ___________

Coded By : _____________

Stamp and Signature of Authorized Dealer


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