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71 (to be furnished to the International Narcotics Control Board (INCB) pursuant to Economic and Social Council resolutions 1981/7, 1991/44, 1993/38 and 1996/30) Country or Territory: Date: Competent office: Title or function: Responsible officer s name: E-mail: Telephone number(s): Fax number(s): Signature: These assessments should be effective as of: This form can also be downloaded from the INCB website at: www.incb.org, under Psychotropic Substances/Tools and Kits/Forms Please.

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