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|width=3%|{{{1|}}} | |width=3%|{{{1|}}} | ||
|width= | |width=30%|{{ #if: {{{2}}} | <span style="white-space:nowrap;float:right;margin-left:.5em">{{{2|}}}</span> | }} {{ #if: {{{3}}} | <span style="font-size: 85%">{{{3|}}}</span> | }} | ||
|width=20% style="text-align:right; font-weight:bold;"|{{{4|}}} | |width=20% style="text-align:right; font-weight:bold;"|{{{4|}}} | ||
|width=7% style="text-align:center; font-weight:bold;"|<span style="white-space:nowrap;display:inline">{{{5|}}}</span> | |width=7% style="text-align:center; font-weight:bold;"|<span style="white-space:nowrap;display:inline">{{{5|}}}</span> |