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- White printed form taped to a light wood paneled door (centered, slight clockwise rotation).
- Top of form: short black horizontal bar (header).
- Center: faint circular seal or emblem partially obscured by a large vertical black rectangle covering central content.
- Lower-left of form: small table/grid with multiple rows and columns (text not legible).
- Lower-right of form: small square with an "X" (placeholder/box).
- Door: vertical grooves/panels; paper attached with small piece of tape at top.

EFTA00000797

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documents/EFTA00000797.pdf
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