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AC Rev. 2000.1 Page 1 of 2 Please Print All Information In BLOCK CAPITAL LETTERS. The more information provided, the better the chance for prompt and accurate service. Mothers Declaration Mothers First (Christian) Name Mothers Middle Name Mothers Surname Mothers Address (Street) SOLD Mothers Address (Town) Mothers Address (Parish) Child s First Name Child s Middle Name Child s Surname BE Date of Birth (dd/mm/yyyy) Day Sex (Circle appropriately) Month Male Year Female TO.

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