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APPLICATION
Please complete in BLOCK and tick boxes where appropriate.
Fields with asterisc(*) are required
PERSONAL DETAILS
FIRST NAME:
SURNAME:
IDENTITY NO.:
NATIONALITY:
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CYPRIOT
OTHER
DATE OF BIRTH:
GENDER:
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MALE
FEMALE
MARITAL STATUS:
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SINGLE
MARRIED
EMPLOYMENT TYPE:
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PRIVATE SECTOR
BANKING SECTOR
GOV/MENT (or) SEMI-GOV/MENT
SELF EMPLOYED
RETIRED
HOUSE-WIFE
STUDENT
OTHER
EDUCATION:
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HIGH SCHOOL
UNIVERSITY GRADUATE
POSTGRADUATE
ADDRESS FOR CORRESPONDANCE
STREET:
NO.:
BUILDING NAME:
AREA:
FLAT NO.:
CITY / VILLAGE:
DISTRICT:
POSTAL CODE:
P.O BOX:
P.O BOX CITY CODE:
HOME PHONE:
BUSINESS PHONE:
MOBILE PHONE:
FAX:
E-MAIL:
DECLARATION
I have read the attached terms and conditions of the Privilege card, and the company’s policy about the protection of personal data and communication with the customers, and I assent to the processing of my personal details by Costas Theodorou Ltd and its affiliated companies for the purposes of maintaining a database, processing data, marketing and statistic research, as well as to be kept informed about information that may possibly interest me and that relate to Costas Theodorou Ltd or my benefits and Privileges as a member of the Costas Theodorou Privilege Card Scheme.
I ACCEPT:
I DO NOT ACCEPT:
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