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And/or previous surname Date of birth Year Identity number or Passport number (mark with ) ID Month Day PP Telephone numbers (dialing code and number) Home Cell Work Fax E-mail address Postal address and postal code Please note: Exemption is not granted from more than half of the maximum number of study units prescribed for a qualification. At which tertiary institution did you pass the study unit(s) below? Study unit(s) from which exemption must be considered? Please print below Uni.

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