|-
| style="border-width: 1px 0px 1px 3px" align="left" |{{{1}}}
| style="border-width: 1px 0px 1px 1px" align="left" |{{{2}}}
| style="border-width: 1px 0px 1px 3px" align="center" |{{{3}}}
| style="border-width: 1px 0px 1px 1px" align="center" |{{{4}}}
| style="border-width: 1px 0px 1px 1px" align="center" |{{{5}}}
| style="border-width: 1px 0px 1px 3px" align="center" |{{{6}}}
| style="border-width: 1px 0px 1px 1px" align="center" |{{{7}}}
| style="border-width: 1px 0px 1px 3px" align="center" |{{{8}}}
| style="border-width: 1px 0px 1px 1px" align="center" |{{{9}}}
| style="border-width: 1px 0px 1px 3px" align="center" |{{{10}}}
| style="border-width: 1px 0px 1px 1px" align="center" |{{{11}}}
| style="border-width: 1px 3px 1px 3px" align="left" |{{{12}}}
{{{13}}}