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Se only 2. Surname at birth (Former family name(s)) / (x) Data della domanda: 3. First name(s) / (x) 4. Date of birth (day-month-year) 5. Place of birth 7. Current nationality 6. Country of birth 8. Sex: Nationality at birth, if different 9. Marital status: Male Female. Single Separated Widow(er) Other (please specify) Married Divorced Numero della domanda di visto: Domanda presentata presso: Ambasciata/Consolato Centro comune Fornitore di servizi Intermediario commerciale Altro No.
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