%%TEMPLATE_DECLARATION_DONE_UPPERCASE%% |  | %%DECLARATIONDATE%% |  |
| %%TEMPLATE_DECLARATION_ADJUSTMENT_UPPERCASE%% |  | %%DECLARATIONADJUSTMENT%% |  | %%CURRENCY%% | %%TEMPLATE_DECLARATION_REFUND_UPPERCASE%% |  | %%DECLARATIONREFUND%% |  | %%CURRENCY%% | %%TEMPLATE_DECLARATION_PAYMENT_UPPERCASE%% |  | %%DECLARATIONPAYMENT%% |  | %%CURRENCY%%
| %%TEMPLATE_DECLARATION_BALANCE_UPPERCASE%% |  | %%DECLARATIONBALANCE%% |  | %%CURRENCY%%