English Translation

47 Command of the chief d. SeichPol. u. d. SD. No. 36/42 367 6. Indication of lost objects: Amortization of the object's monetary value of the item d. Re-exact designation immediately prior to lost object and price acquisition value at the time of item No. Loss (Sp.4-Sp. 5) RM RMRM RM 1 2 3 4 5 6 7. Indication of the damaged items: aa Pe combined Lfd. Exact description of the item Repair costs remaining value (amount Sp. 3 and 4) No RM RM rm 1 2 3 4 5 Appendix 2 8. Amount of lost cash:...........RM. Mt of the items and maximum amounts which are taken into account in granting 9. Whether, when and to what extent aid is already taken into consideration. Aid to self-acquired (own) objects or other objects Lfd. Amount up to be paid: No. Name of the object RMs 1 2 3 4 10. Indication whether from another side aid is paid to the 1 A. items of daily loss, etc.: Bedarls: a) Shaving and washer, comb, (in brushes, mirrors, sewing tools and similar articles) 11. (b) 1 travel ecessaire 15 items and cash amounts are my own 2 writing instruments. 1 fountain pen 10 1 writing folder 10 1 briefcase 20 (signature of the applicant) 1 wallet 8 12. Opinion of the operating department of the 3 suitcase.. 20 carrier (in particular also whether the 4 1 pocket knives. 5 under No. 6 to 8 items listed and 5 (a) 1 pocket or wristwatch 50 cash amounts according to their amount do not exceed the necessary b) 1 watch chain 15 manoeuvrable needs): 6 1 wedding ring or engagement ring, as well as rings representing family thinking 25 7 tobacco products, etc.: a) cigars, cigarettes, tobacco in total 10 13. 1 cigar and cigarette. bag per 5 8 1 purse 5 (service and date) (signature) B. Cameras and music 15. Instruments: Payment of an aid to ...... 6 1 camera with accessories .. 100 in height of ... RM is hereby 10 1 string instrument (violin, approved. A corresponding note is to lute, guitar, zither, etc.) 50 a t tae 1 wind instrument or 1 accordion or 1 harmonica. 50 1 harmonics 5 , .. 194 .. Notes 10 (service) C. Equipment: binoculars, shot and blank (amount of the cost of selves weapons......... or free replacement a. (Signature)