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| ltrlSurveyList |
| ltrlShipperName: | XXShipperNameYY | |
| ltrlSurveyDate: | XXSurveyDateYY | |
| ltrlOriginAddress: | XXOriginAddressYY | XXOriginDescriptionYY |
| ltrlDestinationAddress: | XXDeliveryAddressYY | XXDeliveryDescriptionYY |
| XXContentYY |
| XXCommentsYY |
| ltrlOwnerSignature: | ltrlSurveyerSignature: | |
| ____________________ | ____________________ |