Note:
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Information need only be
inserted in the fourth and fifth columns, relating to melting point and
viscosity, for those substances which have a melting point greater than 0°C
or a viscosity greater than 25 mPa.s at 20°C.
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The transportation of the
product is allowed between the following
countries:.....................................................................................
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Issued at................
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the..........................
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under No.................................
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The undersigned declares that he is duly
authorized by the said Government to issue this Amendment.
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