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{| style="width: 195px; margin-left: auto; margin-right: auto;"
{| style="width: 195px; margin-left: auto; margin-right: auto;"
| style="text-align: left; width: 150px;" | {{{1}}}
| style="text-align: left; width: 150px;" | {{{1}}}
| class="value" style="width: 45px;" | [[file:BL_{{uc:{{{2}}}}}.png|30px]]
| class="value" style="width: 45px; height: 30px;" | [[file:BL_{{uc:{{{2}}}}}.png|30px]]
|-
|-
| class="value" colspan=2 | {{{3}}}
| class="value" colspan=2 | {{{3}}}