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En registered at UCT before? Ring Answer Yes No If YES, please enter fellow/student number SECTION A: PERSONAL DETAILS Prefix: (e.g. Mr, Mrs, Ms) First Name: Middle Name: Last Name: Date of Birth: D D M M Y Y Y Y Last Name on Academic Transcripts (if different from above): Marital Status: (Please tick appropriate box) Single Married Divorced Widowed SA ID number (for SA Citizens or SA Permanent Residents only): SA Citizenship Status: (Please tick the appropriate box) Citizen P.

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