PERSONAL PARTICULARS. Agent Code Title: Mr Xxxxxxx: Miss Ms Other (Specify) Nationality: Initials: First name(s): Identification number: Date of birth: Cellphone number: Tel Work: Marital status: Single Widowed Divorced Married in Out of community of property Residential address: Postal address: E-mail address: Insolvent: Yes No Under legal administration: Yes No Garnishee order: Yes No Accommodation: Rented house or flat Own flat or house Other Number of dependant:
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