<p><strong>Customer :&nbsp;&nbsp;</strong></p>

<hr />
<table border="1" cellpadding="0" cellspacing="0" style="width:100%">
	<tbody>
		<tr>
			<td style="height:20px; text-align:center">&nbsp; <strong>No&nbsp;&nbsp;</strong></td>
			<td><strong>Invoice Number</strong></td>
			<td><strong>Issued Date&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</strong></td>
			<td style="height:35px; text-align:center"><strong>Item</strong></td>
			<td style="text-align:center"><strong>Qty&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</strong></td>
			<td style="text-align:center"><strong>Unit Price&nbsp; &nbsp; &nbsp;</strong></td>
			<td style="text-align:center"><strong>Amount&nbsp;</strong> &nbsp;&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">1</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</td>
			<td style="text-align:right">&nbsp; &nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right; vertical-align:middle">&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">2</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">3</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">4</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">5</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">6</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">7</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">8</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">9</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
		</tr>
		<tr>
			<td style="height:27px; text-align:center">10</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
			<td style="text-align:right">&nbsp;</td>
		</tr>
	</tbody>
</table>
