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Get Indonesia DGT-1 2009

of Income Recipient : ___________________________________________________________________ (19) 2. Date of birth (mm/dd/yyyy) : __/__/____ (20) 3. Are you acting as an agent or a nominee? □ Yes □ No *) (21) 4. Full address: __________________________________________________________________________________ ____________________________________________________________________________________________(22) 5. Do you have permanent home in Indonesia? □ Yes □ No *) (23) 6. In what count.

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