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AGREED FORM

APPENDIX 1 Form of Account Statement


From [yr]/[mth]/[day] to [yr]/[mth]/[day]
Amount owing on the next immediate Repayment Date (date to be inserted) Number of days during which interest is accrued

Transaction date (yr/mth/day)

Value date

Debits

Credits

Account balance

Average Balance

Deposit interest rate

Interest paid

Remarks

Repayment of principal

Interest repayment

Withdrawal from account

Principal

Interest

08/866894_5.DOC

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