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Citizen: Yes X Section 1: Personal Information Id no Surname E-mail address Cell numbers Home tell number Postal address Postal code Population group Do you suffer from any Disability? Are you a South African citizen? Yes No First names Date of birth Your relatives: Province Your own: Is your family home in a rural area? African Yes No Asian Yes No D D M M Y Describe your house Coloured White If yes , please specify Formal/ permanent Gender Female Y Y Y Informal/ sha.

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