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5. Place and date of birth (please note that you are registering your information for the following months, so a total of 6 dates is required to register your information: 1 February 1969, 1 April 1969, 1 June 1969, 2 August 1969, 10 November 1969, 18 February 1970, 24 June 1971, 24 August 1971, 10 November 1972, 18 January 1973)
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