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Child's Name ______________________________________________ Gender M / F
BC No. _____________ Date of Birth ______________ School _________________
Parent's Name _____________________________________________ Gender M / F
NRIC No. _____________ Date of Birth __________ Occupation ________________
Contacts _____________ (hp) ___________ (h) Email _______________________
Address ________________________________________________________________
________________________________________________________________________
Caption _________________________________________________________________
__________________________________________ (must contain the word "Mothercare" )
Photo taken at __________ years, ____________ months (age)
Where did you get your copy of JnU ? ___________________________________________
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