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SECTION A - TO BE COMPLETED BY APPLICANT

section "a" - to be completed by applicant ni 82 yyyy mm dd surname other name(s) (street) (city/district/county) 8. marital status: single married widowed divorced 9. state maiden name (where applicable): surname 12. last employer registration no: (if known) 13. employment record from 10 april, 1972. name of employer address of employer period of

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