第一條　合同范圍
　　_________公司（以下簡稱甲方）和_________公司（以下簡稱乙方），經(jīng)過友好協(xié)商，同意合資經(jīng)營中速船用主機廠。茲同合資經(jīng)營條件尚未成熟，雙方將以補償貿(mào)易進行合作生產(chǎn)并以此作為雙方合作的第一步，其條件如下：
　　1．1　乙方將向甲方轉(zhuǎn)讓生產(chǎn)下列型號中速船用主機（以下簡稱合同產(chǎn)品）的技術(shù)秘密及全部技術(shù)資料，其型號如下：
　　　　12v——400zc中速船用主機；
　　　　12v——600zc中速船用主機。
　　1．2　“技術(shù)文件資料”的定義范圍及交付：
　　本合同1．1款所指的技術(shù)資料（以下簡稱資料）定義是乙方提供合同產(chǎn)品的技術(shù)資料由三大部分組成：即乙方現(xiàn)用的一般技術(shù)資料，產(chǎn)品設(shè)計圖紙和生產(chǎn)技術(shù)資料，上述資料方包括詳細的技術(shù)秘密。
　　　?。?）一般技術(shù)資料包括：
　　　　　　a．12v—600zc中速船用主機的技術(shù)規(guī)范（包括部裝、總裝、試車、交貨試驗等）；
　　　　　　b．12v—400zc中速船用主機的主要零部件的技術(shù)規(guī)范；
　　　　　　c．合同產(chǎn)品中所使用的配套產(chǎn)品的外型尺寸、安裝尺寸和性能參數(shù)的樣本，
　　　?。?）產(chǎn)品設(shè)計圖紙：
　　　　乙方提供合同產(chǎn)品的產(chǎn)品設(shè)計圖紙應(yīng)包括：
　　　　　　a．合同產(chǎn)品的全套施工圖紙（包括總裝圖、部件圖、系統(tǒng)圖、原理圖及全部零件的詳細圖紙）；
　　　　　　b．合同產(chǎn)品的計算資料和計算書；
　　　　　　c．有關(guān)船級社發(fā)給的證書及交船級社驗證的圖紙、計算書及其他資料清單；
　　　　　　d．試驗書設(shè)計圖紙及其技術(shù)文件。
　　　?。?）生產(chǎn)技術(shù)資料：乙方提供的合同產(chǎn)品的生產(chǎn)技術(shù)資料應(yīng)包括合同產(chǎn)品全部工藝性指導(dǎo)文件及主要零件的詳細制造技術(shù)資料；對原材料和合同產(chǎn)品零部件在生產(chǎn)過程中和生產(chǎn)后的質(zhì)量檢驗要求，驗收手段，驗收步驟及驗收技術(shù)文件。
　　　?。?）資料的修改：若乙方采用新技術(shù)改進產(chǎn)品、改進工藝過程，降低等需要對提供的資料進行修改時，應(yīng)將修改的結(jié)果以書面形式提供給甲方。
　　　?。?）資料的提供方式：
　　　　　　a．對一般技術(shù)文件應(yīng)提供三份藍圖或同等數(shù)量的清晰的復(fù)制圖；
　　　　　　b．對產(chǎn)品設(shè)計圖紙應(yīng)提供一份生產(chǎn)底圖及兩份藍圖；
　　　　　　c．對生產(chǎn)技術(shù)資料應(yīng)提供兩份藍圖；
　　　　　　d．對已提供過的完全相同的重復(fù)資料，可免于提供，但需在清單中予以注明。
　　　　（6）資料的交付進度：
　　　　　　a．根據(jù)資料定義的規(guī)定，為生產(chǎn)12v—400zc型中速船用主機需要，乙方在簽訂合同后30天內(nèi)需向甲方交付合同產(chǎn)品的全部技術(shù)資料和全部圖紙；
　　　　　　b．根據(jù)資料定義的規(guī)定，為生產(chǎn)12v—600zc型中速船用主機的需要，乙方在鑒訂合同后于_________年_________月_________日前，需向甲方交付合同產(chǎn)品的全部技術(shù)資料和圖紙。
　　1．3　甲方將生產(chǎn)的產(chǎn)品向乙方返銷如下：
　　　　12v—400zc型中速船用主機，每年_________臺；
　　　　12v—600zc型中速船用主機，每年_________臺。
　　1．4　以補償貿(mào)易進行合作生產(chǎn)期限為2年，2年后若合資經(jīng)營條件不成熟，則可延長合作生產(chǎn)期限，但最長不得超過5年。
第二條　轉(zhuǎn)讓技術(shù)秘密和技術(shù)文件
　　2．1　乙方向甲方提供合同產(chǎn)品的設(shè)計計算、產(chǎn)品圖紙、制造工藝、質(zhì)量控制和試驗安裝、調(diào)試、運轉(zhuǎn)及維修等有關(guān)合同產(chǎn)品的全部技術(shù)資料，必須和乙方目前使用的資料內(nèi)容相同。
　　2．2　合同產(chǎn)品資料的審核和驗證：
　　乙方對提供給甲方的產(chǎn)品設(shè)計圖紙、制造技術(shù)資料的完整性、正確性、清晰性負責?？串a(chǎn)品設(shè)計圖紙和生產(chǎn)技術(shù)資料中的任何部分發(fā)現(xiàn)有失誤，當乙方接到甲方通知時立即補齊遺失部分或更改錯誤部分。
　　2．3　在合作生產(chǎn)期間，乙方將以最優(yōu)惠價格向甲方提供甲方方面市場不能提供的零部件。具體內(nèi)容另行商定。
　　2．4　乙方保證向甲方轉(zhuǎn)讓的技術(shù)秘密和技術(shù)資料不受任何第三者的指控。
第三條　價格和支付方式
　　3．1　為了支付轉(zhuǎn)讓2．1條款中所規(guī)定的12v一400zc型中速船用主機的技術(shù)秘密和技術(shù)資料費用，乙方應(yīng)向甲方交付費用如下：
　　　　_________年_________u．s．d（大寫_________元整）
　　　　_________年_________u．s．d（大寫_________元整）
　　　　_________年起以后的_________年中按每年將產(chǎn)值（即每年總產(chǎn)值扣除進口部分價值和稅收費用后的產(chǎn)值）其提成費為_________％。
　　3．2　合同簽署生效后三十（30）天內(nèi)，甲方按照由銀行提交的乙方下列單據(jù)，予以第一次支付總金額的_________％，即_________u.s.d（大寫：_________美元整）
　　　?。?）根據(jù)附件_________要求，提供第一批資料的空運提單；
　　　　（2）經(jīng)甲方確認的__________________銀行出具不可撤銷的保函，正副本各一份；
　　　?。?）乙方方的商業(yè)發(fā)票：一式兩份；
　　　?。?）乙方方即期匯票一式兩份。
　　3．3　于_________年_________月_________日甲方按收到乙方提交的下列單據(jù)后，予以第二次交付_________年總金額的_________％現(xiàn)金，即u．s．d（大寫：_________美元整）。
　　　?。?）按附件_________要求于_________年_________月_________日提供第二批資料空運提單。
　　　?。?）乙方方商業(yè)發(fā)票一式兩份。
　　　?。?）乙方方即期匯票一式兩份。
　　3．4　雙方同意_________年用現(xiàn)金支付，_________年付_________％現(xiàn)金，其余_________％金額用甲方返銷產(chǎn)品補償。
　　3．5　_________年的費用本年_________月_________日支付，乙方方交付商業(yè)發(fā)票一式兩份。
　　3．6　自_________年起及其各年份按3．1款規(guī)定的提成費用應(yīng)在每年_________月_________日在收到乙方方商業(yè)發(fā)票（一式兩份）后支付。
　　3．7　在合作生產(chǎn)期間鑒于甲方遵照3．1款已向乙方交付了轉(zhuǎn)讓技術(shù)秘密的部分費用，各合資經(jīng)營時機成熟，雙方同意成立合資經(jīng)營企業(yè)時，則乙方將其剩余部分的技術(shù)秘密費用可作提資的一部分。一旦雙方不能進行合資經(jīng)營，在五（5）年之內(nèi)合作生產(chǎn)被迫終止時，甲方確認向乙方支付技術(shù)秘密費用的剩余部分。若出現(xiàn)上述情況，對支付技術(shù)秘密費用的進度和方式由雙方在通常時候予以協(xié)商。
第四條　合作生產(chǎn)的補償貿(mào)易
　　4．1　為有利甲方的外匯平衡，乙方同意甲方生產(chǎn)12v—400ze，12v—600zc中速船用主機返銷給乙方。
　　4．2　上述訂單的總價必須保證不低于甲方每年向乙方反付購買零部件所需費用總額的_________％。乙方同意在甲方補償能力擴大及乙方需求擴大的前提下，其補償?shù)陌俜直瓤梢圆皇芟拗啤?br />　　4．3　甲方將以優(yōu)惠價格向甲方提供產(chǎn)品，其品種、數(shù)量、交貨期等將由雙方在每批合同中商定。甲方產(chǎn)品必須符合乙方的標準。
　　4．4　乙方要求在甲方接到上述產(chǎn)品圖紙后立即試制12v—400zc型中速船用主機。首批產(chǎn)品各一臺將分別在雙方進行試驗，在試驗合格的基礎(chǔ)上乙方要求甲方于_________年內(nèi)提供12v—400zc型中速船用主機_________臺。其價格、交貨期在簽訂正式合同時商定。
第五條　?！∽C
　　5．1　乙方保證，在合同有效期內(nèi)所供應(yīng)的資料應(yīng)是最新技術(shù)的代身，其內(nèi)容和甲方目前使用的完全一致。
　　5．2　乙方保證所供資料是完整的、正確的、清晰的。
第六條　稅　費
　　6．1　凡因履行本合同需繳納的一切稅收，發(fā)生在甲方方以外的均由乙方承擔。
　　6．2　凡因履行本合同需繳納的一切稅費，發(fā)生在甲方以內(nèi)的均由甲方承擔。
第七條　商　標
　　7．1　甲方有權(quán)使用乙方商標和合同產(chǎn)品的序號。甲方將下列商標標明在甲方所生產(chǎn)的合同產(chǎn)品上。
　　7．2　甲方制造的鉻牌、報價單、技術(shù)規(guī)格書、廣告、說明書、樣本等，凡是合同產(chǎn)品均以甲方名稱來表示。
第八條　包　裝
　　8．1　須用堅固的木箱包裝，適合長途海運、防濕、防潮、防震、防銹、耐粗暴搬運。由于包裝不良所發(fā)生的損失，賣方應(yīng)負擔由此而產(chǎn)生的一切費用和／或損失。
　　8．2　賣方應(yīng)在每件包裝上，用不退色油漆清楚地標刷件號、尺碼、毛重、凈重、“切勿受潮”等字樣，并刷有下列嘜頭：_________
　　8．3　裝箱單兩份，注明毛重、凈重、尺碼和所裝貨物每項的品名和數(shù)量。
第九條　人力不可抗拒
　　9．1　簽約雙方中的任何一方由于戰(zhàn)爭及嚴重的火災(zāi)、水災(zāi)、臺風和地震或其他雙方同意的事件而影響執(zhí)行合同時，雙方同意延長合同期限，延長時間相當于事故所影響的時間。
　　9．2　責任方應(yīng)盡快將發(fā)生的人力不可抗拒事故的情況用電報通知另一方，并在十四（14）天以內(nèi)以航空、掛號信將有關(guān)部門出具的證明文件交給另一方確認。
　　9．3　受人力不可抗拒事故延續(xù)到一至二十（20）天以上時，雙方應(yīng)通過友好協(xié)商盡快解決合同繼續(xù)執(zhí)行的問題。
第十條　仲　裁
　　10．1　因執(zhí)行本合同所發(fā)生的或與本合同有關(guān)的一切爭執(zhí)，雙方應(yīng)通過友好協(xié)商解決。已經(jīng)協(xié)商仍不能達成協(xié)議時，則提交仲裁解決。
　　10．2　仲裁地點在瑞典斯德哥爾摩商會。
　　10．3　仲裁裁決是終局裁決，對雙方均有約束力。
　　10．4　仲裁費用除仲裁機關(guān)另有裁決外，應(yīng)由敗訴方負擔。
　　10．5　除了在仲裁過程中進行仲裁的那部份外，合同的其余部分在仲裁期間仍繼續(xù)執(zhí)行。
第十一條　合同生效及其他
　　11．1　本合同于_________年_________月_________日由雙方代表在_________正式簽字，自簽字之日起1周內(nèi)本合同應(yīng)經(jīng)有關(guān)部門批準后生效。
　　11．2　本合同以英文書就一式四份，雙方各執(zhí)一式兩份。
　　11．3　本合同有效期見第十一條所述。
　　11．4　本合同附件為本合同不可分割的部份，與正文有同等效力。
　　11．5　雙方在本合同生效前交換的所有文件、函電等在本合同生效的同時自動失效。
　　11．6　本合同只能根據(jù)同雙方授權(quán)代表簽名或蓋章的書面文件進行變更、追加或修改。
　　11．7　在執(zhí)行合同期內(nèi)雙方的通訊均以函電進行，書信往來一式兩份。
第十二條　法定地址
　　甲方地址：_________
　　乙方地址：_________
甲方（蓋章）：_________　　　　　　　　乙方（蓋章）：_________
法定代表人（簽字）：_________　　　　　法定代表人（簽字）：_________
_________年____月____日　　　　　　　　_________年____月____日
簽訂地點：_________　　　　　　　　　　簽訂地點：_________
附件article 1
　　_________.（hereinafter referred to as part a）and _________.（hereinafter referred to as part b）
　　have agreed， after friendly discussion， to run a medium speed marine main engine factory in the form of a joint - venture company. since the conditions for the joint - venture are not yet ready， both parties shall start up a joint - production with compensation trade as the first step of co - operation with the following conditions:
　　1.1　part b shall transfer the technical know - how and the complete technical documentation to part a for manufacturing medium speed marine main engines （hereinafter called contracted products） of the following types:
　　　　12v- 400zc medium speed marine main engine;
　　　　12v- 600zc medium speed marine main engine.
　　1.2　definition， scope and delivery of technical documentation: the definition of technical documentation （hereinafter referred to as documentation） in article 1.1 of this contract means that the contracted products supplied by part b are composed of three parts: general technical documentation， products design drawings and manufacturing technical documentation， as used by part b. all of them should contain the technical know - how details.
　　　?。?）general technical documentation includes:
　　　　　　a.　the technical specifications of the medium speed marine main engine of type 12v- 600zc （including sub - assembly， assembly， test run， delivery tests， etc. ）;
　　　　　　b.　the technical specifications of the main components of the medium speed marine main engine of type 12v - 400zc;
　　　　　　c.　overall dimensions， installation dimensions， and performance data of the accessories used by the contracted products.
　　　　（2）products design drawing:
　　　　　　products design drawings of the contract products supplied by part b， shall inclued:
　　　　　　a.　a complete set of production drawings of the contracted products （including the final assembly drawings， components drawings， system diagram， principle diagram， and detailed drawings of all components）;
　　　　　　b.　the calculating data and calculation manual of the contracted products;
　　　　　　c.　drawings， calculating manual and other data given to the classification societies and certificate issued by the classification societies;
　　　　　　d.　test platform design drawings and its technical documents.
　　　?。?）manufacturing technical documentation:
　　　　　　manufacturing technical documentation of the contracted products provided by part b shall include: the whole detailed instructive documentation and main components for the manufacturing of the contracted products， which shall include: requirements of quality inspection means， processes and technical conditions of acceptance test to the raw materials and components of the contracted products during and after the manufacturing processes.
　　　　（4）modification of documentation:
　　　　　　if the documentation to be supplied is modified by site as a result of using new technology to improve the products， processes and reduce the cost， the detailed information shall be submitted to part a in written form.
　　　?。?）mode of providing documentation:
　　　　　　a.　for general technical documentation， three prints of three legible copies should be provided;
　　　　　　b.　for design drawings， one manufacturing transparency and two prints shall be provided;
　　　　　　c.　for manufacturing technical documentation， two prints shall be provided;
　　　　　　d.　the duplicated documentation， which had been supplied before， can be exemped， but must be noted in the list.
　　　?。?）delivery schedule of documentation:
　　　　　　a.　according to the definition of documentation， in order to facilitate the manufacturer of medium speed marine main engine of type 12v - 400zc， part b shall deliver the whole technical documentation and drawing of contracted products to part a within 30 days after the signing of the contract;
　　　　　　b.　according to the definition of documentation in order to manufacture the medium speed maline main engine of type 12v - 600zc， site shall submit to part a the whole technical documentation and drawings of the contracted products before_________$$$after the signing of the contract.
　　1.3　the products manufactured by part a shall be resold to part b as follows:
　　　　medium speed marine engine of type 12v - 400zc_________sets per year;
　　　　medium speed marine engine of type 12v- 600zc_________sets per year;
　　1.4　the period of joint - production with compensation trade is two years. should the conditions for establishing a joint - venture be still not ready after the said period， the said period can be extended， but in no circumstances shall it be extended for more than five years.
article 2 transfer of technical know- how and technical documentation
　　2.1　the complete technical documentation of designs， calculations， drawings， manufacturing processes， quality control， tests， installation， adjustment， operation and maintenance shall be provided by part b to part a concerning the contracted products and must be the same as those being currently used by part b.
　　2.2　checking and verifying the documentation of the contracted products:
　　　　part b shall be responsible for the completeness， correctness and legibility of the product design drawings and manufacturing technical documentation sent to part a. in case any part of the said drawings and documentation are missing， part b shall make supplementary delivery of correction immediately upon notification by part b.
　　2.3　during the joint- production period， part b shall， at most favoured prices， supply part a with spare parts of the contracted products which are not available in the market of part a's side. these supplies are subject to separate agreements in due course.
　　2.4　part b guarantees that the transfer of the technical knowhow and technical documentation hereof will not involve any accusation from any third party.
article 3 prices and termsof payment
　　3.1　part a shall pay part b for the transfer of technical knowhow and technical documentation of the medium speed marine main engine of type 12v- 400zc stipulated in clause 2.1 as follows:
　　　　_________us _________（say: _________u.s.d. only）
　　　　_________us _________（say: _________u.s.d. only）
　　during the 2 years'period commencing from 19 ，the yearly fee shall be taken as _________% of the net annual production value （total annual production value minus the value of the imported parts and tax expenses）.
　　3.2　the first payment is us $ _________（say: _________u.s.d.only） constituting
　　　　% of total payment and shall be made within 30（thirty） days after the contract is signed and comes into force， upon receipt of the following documents from part b through the bank_________:
　　　?。?）supply air- freight bill of the first batch of documentation according to the requirement of appendix_________;
　　　?。?）irrevocable letter of guarantee in duplicate（one original，one copy）issued by_________band and confirmed by part a.
　　　?。?）part b commercial invoice in duplicate;
　　　?。?）part b sight draft in duplicate.
　　3.3　the second payment shall amount to _________% of the total payment due in _________， i.e. _________u.s.d. （say: _________u.s.d. only） and shall be paid to part b on _________， _________. upon the receipt by part a from part b of the following documents:
　　　?。?）air - freightbillof thesecondbatchof documentationdeliveredbypart bon_________， _________，pursuant to stipulations in appendix_________;
　　　?。?）part b commercial invoice in duplicate;
　　　?。?）part b sight draft in duplicate.
　　3.4　both parties agree to settle in cash in _________while the settlement in _________will be_________% in cash and the remaining _________% shall be made through compensation of resale from part a.
　　3.5　the payment of _________ will be due on_________ th _________of the year upon receipt of the commercial invoices in duplicate from part b.
　　3.6　the yearly payments from 19　onward as per clause 3.1. are due on _________， _________， of each year upon receipt of 2 copies of the commercial invoice from part b.
　　3.7　part of the know - how transferring fee would be paid to part b by part a as per clause 3.1. during the joint - production period， and the unpaid part would be converted as the investment of part b to the joint - venture when the joint-venture comes to realisation. should the joint - venture miscarry and the joint- production be forced to terminate within 5 （five） years， part a shall confirm that the unpaid part of the know - how transferring fee shall fully be remitted to part b by part a. in each of the above - mentioned cases， evaluating the mode of payment of the know - how transferring fee shall be agreed upon by both parties through consultation in due course.
article 4 joint- production andcompensation trade
　　4.1　for the purpose of balancing part a' s foreign exchange， part b agrees to buy - back the medium speed marine main engines of type 12v- 400zc and 12v- 600zc produced by part a.
　　4.2　the total value of the above mentioned orders shall not be less than _________% of the expenses for purchasing components by part a from part b. part b agrees that under the prerequisite of increased compensation capability of part a and increased demand of part b the percentage of payments compensated through the back - sale of pite's products can be increased without limitation.
　　4.3　products supplied to part b by part a shall be at favourable prices， types， quantity， and delivery time of the products shall be agreed in the contract for every order by both pareties. quality of part a's products has to meet part b's standard.
　　4.4　part b shall require part a to start the trial production of medium speed marine main engine of type 12v - 400zc immediately upon receiving their drawings. the first products， one for each party， shall be tested separately by both parties and part b shall， on the basis of satisfactory tests， require part a to deliver_________（ _________）sets of medium speed marine main engine of type 12v- 400zc within 19 _________. the prices and delivery periods shall be agreed upon when the contract is concluded.
article 5 guarantee
　　5.1　part b guarantees that the documentation supplied shall be of the latest technological achievement within the valid period of the contract and shall be exactly identical with the documentation currently used by part b.
　　5.2　part b guarantees that the documentation supplied shall be complete， correct and legible.
article 6 tax and duty
　　6.1　all taxes， customs and other duties in connection with the performance of the contract arising outside the part a side shall be borne by part b.
　　6.2　all taxes， customs and other duties in connection with the performance of the contract arising inside the part a side shall be borne by part a.
article 7 trademark
　　7.1　part a shall have the right to use the part b trademark and serial number of contracted products. part a shall label the trademark smith - portla co， ltd. on the contracted products so produced.
　　7.2　nameplates， quotations， technical specifications， advertisement， instruction manuals， samples of the contracted products manufactured by part a shall all be labelled with the name of part a.
article 8 packing
　　8.1　packing shall be in the form of strong wooden case （s） suitable for long voyage and well protected against dampness， moisture， shock， rust and rough handling. the seller shall be liable for any damage to the goods and extra expenses due to improper packing， inadequate or improper protective measures.
　　8.2　the package number， measurements， gross weight， net weight， the words "keep away from moisture"and the following shipping marks shall be printed with fadeless paint on each package:
　　　?。?）part b/part a 12v - 400zc
　　　　（2）part b/part a12v- 600zc
　　8.3　packing list in duplicate indicating gross and net weight，measurements and quantity of each item is included.
article 9 force majeure
　　9.1　should either party of the contract be prevented from implementing the contract by such cases of force majeure as war， serious fire， flood， typhoon and earthquake， or other events confirmed by both parties， the time for implementing the contract shall be extended by a period equal to the effect of such force majeure.
　　9.2　the party concerned shall notify the other party by cable within the shortest possible time after occurrence of the force majeure and send by registered airmail within 14 （fourteen） days to the other party a certificate issued by relevant authorities for confirmation.
　　9.3　should the effects of force majeure continue for more than 120 （one hundred twenty） consecutive days， both parties shall settle further execution of the contract through friendly negotiations as soon as possible.
article10 arbitration
　　10.1　all disputes relating to the contractor arising from the execution of the contract shall be setfled through friendly consultations between both parties. should no settlemnt be reached， the disputes shall be submitted to arbitration.
　　10.2　the arbitration shall take place in stockholm， sweden， and be conducted by the arbitration institute of the stockholm chamber of commerce.
　　10.3　the arbitration award shall be final and binding on both parties.
　　10.4　the arbitration fee shall be borne by the losing party except otherwise awarded by the arbitration institute.
　　10.5　in the course of arbi. tration， the contract shall continuously be executed by both parties except for the part which is under arbitration.
article 11 effectivenessof the contract and miscellaneous
　　11.1　this contract is formally signed by the representatives of both parties in_________/ （place） on
　　　　_________， and shall be approved by the relevant authorities within one week to become effective.
　　11.2　this contract shall be written in english in four copies. each party shall keep two copies.
　　11.3　the duration of the contract is stipulated in art. 11.
　　11.4　appendix to the contract shall form an integral part of the contract and shall have the same binding force as the contract itseff.
　　11.5　all documents， letters， telegrams and telexes interexchanged between both parties before the signing of the contract shall become null and void automatically from the date on which the contract comes into force.
　　11.6　this contract can only be altered， amended and supplemented in accordance with the documents which have been signed or stamped by the authorised representatives of both parties.
　　11.7　letters， telegrams and telexes shall be used for communication between both parties during the contracted period. letters shall be in duplicates.
article 12 legal addresses
　　parta（address）：_________　　　　　　partb（address）：_________

party a(signature):_________　　　　　 party b(signature):_________


date:_________　　　　　　　　　　　　 date:_________