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General Informations  


Your Gender:      
Birth Date: Day /MM /Year
Marital Status:         I Identify as:

Contact Info.


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Occupation Info.
Consumer Info.

What credit cards do you have : Visa  Mastercard   Amex   Store Card
Who is your primary bank:  
Into which category does your entire household income belong:
 

In relation to your primary car, what is the:
 

Make: (ie. Holden)   Model: (ie. Falcon)
Year Made:   Insured with:
Company Car:   Member of:
Own a Motor Bike:  

             

Children
Personal Items Do you smoke:     Thinking of Quitting:
Wear spectacles/lenses :  
Which do you use for TV viewing:
       
       
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Own your own Home:   Renting:
Financed with:
Have private Health Insurance:
Have any Medical Conditions :       Other:

General Rewards program:
                         
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Airline Rewards program:      
Investments:   
                      
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Your Nationality/Ethnic Heritage:     
Visa Status:             
Are you a:  Blood Donor   Organ Donor   Volunteer
Do you receive (Centrelink) any of the following :
   


Please make sure you answer the following Questions:

Hear about us from:   Friend's Name:
Taken part in MR groups before :
Registered with other Recruiting Organisations :

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