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Get Filled Medif Form

Is' (x) em 'Sim ou N o' Use LETRA DE FORMA ou DIGITA O para completar esta folha A B (Answer ALL questions -- put a cross ( ) in YES or NO boxes) (Use BLOCK LETTERS or TYPEWRITER when completing this form) NOME/INICIAIS/T TULO: NAME/INITIALS/TITLE: ITINER RIO PROPOSTO (PROPOSED ITINERARY) Empresa(s), n do(s) v o(s), classe(s), data(s), trecho(s), situa o da reserva da continua o da viagem. Airline(s), flight number(s), class(es), date(s), segment(s), reservation.

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