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[null,"★收款人資料 Creditor's Information:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"IT","ITALY"]
[null,null,"收款人帳號 \nCreditor's A/C /IBAN No.:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"JP","JAPAN"]
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[null,null,"收款人名稱 Creditor:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"JO","JORDAN"]
[null,null,"收款人地址及電話 Creditor's Address & TEL No.:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"KR","KOREA,REPUBLIC OF"]
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[null,null,"對收款人之附言 Message to Creditor:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MO","MACAU"]
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[null,"★匯款手續費支付 Details of Charges:（未勾選者視同各自負擔 If not selected, banking charge is borne by each side）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,"MM","MYANMAR"]
[null,null,null,"SHAR: 由匯款人及受款人各自負擔 Borne by each side",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NL","NETHERLANDS"]
[null,null,null,"DEBT: 由匯款人負擔 For Debtor's A/C",null,null,null,null,null,null,null,null,null,null,"Banking charge and Cable Fee 扣款帳號 Debit A/C No.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NZ","NEW ZEALAND"]
[null,null,null,"CRED: 由受款人負擔 For Creditor's A/C (手續費將由匯款金額直接扣除)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NO","NORWAY"]
[null,"★本金繳款方式 Source of Funds:（請勾選下列方式）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OM","OMAN"]
[null,"1.",null,"同意由本人/本公司帳戶扣款，於申請人簽章處蓋上原印鑑視同授權扣帳。(I/We agree that you may withdraw from my/our account by bearing the signature or seal above which is identical to the one registered with you, regarded as the authorization of withdrawals)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,"PK","PAKISTAN"]
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[null,null,"與銀行聯絡事項:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"WS","SAMOA"]
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[null,"【其他資訊提供 Other Information】(非必填欄位 Optional fields)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SG","SINGAPORE"]
[null,"原始匯款人資料 Ultimate Debtor's Information:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"最終收款人資料 Ultimate Creditor's Information:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SK","SLOVAKIA"]
[null,null,"姓名 Ultimate Debtor: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"姓名 Ultimate Creditor: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ZA","SOUTH AFRICA"]
[null,null,"聯絡住址 Address:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"聯絡住址 Address:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ES","SPAIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"LK","SRI LANKA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SE","SWEDEN"]
[null,"*城市City/Town:                                   ",null,null,null,null,null,null,null,null,"*國別/地區 Country:",null,null,null,null,null,null,null,null,"*城市City/Town:                                   ",null,null,null,null,null,null,null,null,"*國別/地區 Country:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CH","SWITZERLAND"]
[null,"以下由銀行內部使用 For Bank Use Only",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"匯款申請人簽章",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TW","TAIWAN"]
[null,"匯率",null,null,null,null,null,null,null,null,"折合新臺幣",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"XA","TAIWAN (OBU)"]
[null,"備註:",null,null,null,null,null,null,null,null,"手續費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TH","THAILAND"]
[null,null,null,null,null,null,null,null,null,null,"郵電費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TR","TURKEY"]
[null,null,null,null,null,null,null,null,null,null,"提領費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AE","U.A.E."]
[null,null,null,null,null,null,null,null,null,null,"收　費",null,null,null,null,null,"發　電",null,null,null,null,null,"授權扣帳\n印鑑照合",null,null,"申請人簽章 Signature of Debtor",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"GB","UNITED KINGDOM"]
[null,null,null,null,null,null,null,null,null,null,"主管",null,null,"作成",null,null,"主管",null,null,"作成",null,null,null,null,null,"本人/敝公司請求貴行辦理上述匯款，而本人/敝公司願遵守本申請書第二頁所載之申請條款。\nI/We request you to execute the remittance in accordance with the provisions on the 2nd page hereof.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"US","UNITED STATES"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"UY","URUGUAY"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VN","VIETNAM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VG","VIRGIN ISLANDS(BRITISH)"]
[null,"(E5002) Electronic Application",null,null,null,null,null,20250407,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2-1",null,null,null,null,null,null,null,null,null,null,null,null,null,"AF","AFGHANISTAN"]
[null,"Note：使用此申請書時，本人/本公司同意不更動除填記欄位以外之申請書內容及文字，若更動該申請書內容或文字而造成 貴行損失時願負一切責任。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AL","ALBANIA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DZ","ALGERIA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AS","AMERICAN SAMOA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AD","ANDORRA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AO","ANGOLA"]
[null,"申　請　條　款",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"To","Mizuho Bank, Ltd.\nTaipei Branch/Taichung Branch\nKaohsiung Branch\nOffshore Banking Unit Taiwan\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AI","ANGUILLA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AQ","ANTARTICA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AG","ANTIGUA AND BARBUDA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AM","ARMENIA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AW","ARUBA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AZ","AZERBAIJAN"]
[null,"1.","(1)","貴行得自由選定通匯銀行或貴行之海外分行（以下簡稱為關係銀行）處理本件匯款。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1.","(1)","You may execute this remittance through your correspondents and/or your overseas branches/agencies (such banks are hereinafter referred to as “Banks Concerned”) designated by you, and",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BS","BAHAMAS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BB","BARBADOS"]
[null,null,"(2)","貴行得自由選用日常語言、暗號、密碼等通知關係銀行。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(2)","you may use explicit language, code and/or cipher, etc. at your discretion in any messages to the Banks Concerned.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BY","BELARUS"]
[null,"2.","如果以受款人居住國以外之貨幣匯款時，得按關係銀行中付款銀行於付款時之買入匯率換算後付款之。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2.","In case the remittance is directed to the paying bank, one of the Banks Concerned, in currency other than that of the country where the payee resides, it may be payable to the payee in the currency of the said country at the then buying rate of the paying bank.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BZ","BELIZE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BJ","BENIN"]
[null,"3.","因非可歸責於貴行之事由而發生下列損失時，本人／敝公司願自負全責。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3.","We shall be responsible for any of the following losses or damages incurred for reasons not attributable to you:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BM","BERMUDA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BW","BOTSWANA"]
[null,null,"(1)","因關係銀行之作為或不作為所引起之損失。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(1)","arising from any acts or failure to act on the part of the Banks Concerned.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BT","BHUTAN"]
[null,null,"(2)","因信件或電話在傳送中之遲延或遺失以及電信之殘缺、錯誤等所引起之不可抗力之損失。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(2)","arising from delayed delivery or loss in transit of letters or telegrams relative to this remittance and/or arising from mutilation, and errors, etc. in transmission of telecommunications, in case those should be due to any causes beyond your control.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BO","BOLIVIA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BA","BOSNIA-HERZEGOVINA"]
[null,null,"(3)","因法令等之限制所引起之損失。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(3)","caused by act or decree of any government or government agency, and/or",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BV","BOUVET ISLAND"]
[null,null,"(4)","因提供之匯款資訊錯誤、不完整或缺漏等，導致無法匯款或延遲匯款等所引起之損失。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(4)","caused by transaction failure or delay, due to incorrect, incomplete or missing remittance information.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"IO","BRITISH INDIAN OCEAN TERRITORY"]
[null,null,"(5)","其他原因所引起之損失，雖然貴行已盡相當之注意。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(5)","arising from any other causes whatsoever after your having treated this remittance with reasonable care.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BN","BRUNEI DARUSSALAM"]
[null,"4.","遇本人／敝公司向貴行請求取消本件匯款時，請以下列方法退還結匯款。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"4.","You shall refund, if requested by me/us,",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BG","BULGARIA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BF","BURKINA FASO"]
[null,null,"(1)","退款應在貴行自關係銀行取得有效之匯款取消確認書後為之。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(1)","upon receipt of confirmation from the Banks Concerned of effective cancellation.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BI","BURUNDI"]
[null,null,"(2)","貴行自關係銀行取得之外匯應按退還時之貴行買入匯率換算並扣除貴行及關係銀行之手續費及一切費用後退還之。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(2)","for the NT$ equivalent of the exchange actually received from the Banks Concerned at your Buying Rate of the time of refundment less fees and expenses due to you and/or the Banks Concerned.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CM","CAMEROON"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CV","CAPE VERDE"]
[null,"5.","有關本件匯款之貴行及關係銀行之手續費及一切費用一經貴行請求，本人／敝公司願立即支付，絕無異議。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5.","All charges and expenses of yourselves and of the Banks Concerned in connection with this remittance shall be paid by me/us upon request.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CF","CENTRAL AFRICAN REPUBLIC"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TD","CHAD"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CX","CHRISTMAS ISLAND"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CC","COCOS(KEELING) ISLANDS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"KM","COMOROS"]
[null,null,null,"此　致",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CK","COOK ISLANDS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CR","COSTA RICA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CI","COTE D'IVOIRE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HR","CROATIA"]
[null,"日商瑞穗銀行股份有限公司",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CU","CUBA"]
[null,"臺北分行/臺中分行/高雄分行/國際金融業務分行",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CY","CYPRUS"]
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