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SCHEDULE 'D'
PERIOD : _____________________________________________________
AUTHORIZED DEALER : ________________________________________
CURRENCY* /PURCHASED/SOLD : ________________________________
COUNTRY : ___________________________________________________
| No. | Date | Amount | # PURPOSE | ||
| Million | Th. | Units | |||
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Total |
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# In case of purchase give purpose code 6103 and for sale code No 2013
* Delete not applicable
Stamp and Signature of Authorized Dealer
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