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Only data items marked with an asterisk are compulsory

Name *

Surname *

E-mail address *

Date of birth *

Place of birth *

Province

Tax code

Citizenship

Gender *

M F D

Marital status

Residential address

Country *

Province *

street name *

Street number *

Town/City *

Post code

Domicile address

Country

Province

street name

Street number

Town/City

Post code

Phone number

Alternative phone number

Other information

Do you have a relative who works in the SACMI group? *

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