<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XML Spy v4.0.1 U (http://www.xmlspy.com)-->
<ACRF xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="ACRF_20033.xsd">
    <Form>
        <Identification>ACRF001</Identification>
        <FormCreationDate>2003-06-25</FormCreationDate>
        <FormCreationHour>14:37:04.015</FormCreationHour>
        <AttestationStatus>0</AttestationStatus>
        <TypeForm>FA</TypeForm>
        <FileReference>
            <FileName>GO.DMFA.123456.20030625.00001.R.1</FileName>
            <ReferenceOrigin>2</ReferenceOrigin>
            <ReferenceNbr>340000E59V01Q</ReferenceNbr>
        </FileReference>
        <ReceptionResult>
            <ResultCode>1</ResultCode>
        </ReceptionResult>
    </Form>
</ACRF>
