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<div class="panel-heading"><h3 class="panel-title">
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<div class="panel-body">
	<fieldset class="form-horizontal">
		<div class="form-group" style="border-bottom: dotted 1px #DDD;">
			<label class="col-xs-3 control-label">Date</label>
			<div class="col-xs-9">
				<div class="form-control-static"><%%COMBOTEXT(date)%%></div>
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		<div class="form-group" style="border-bottom: dotted 1px #DDD;">
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		<div class="form-group" style="border-bottom: dotted 1px #DDD;">
			<label class="col-xs-3 control-label">Contre valeur francs CFA</label>
			<div class="col-xs-9">
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		<div class="form-group" style="border-bottom: dotted 1px #DDD;">
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