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Levy Nr:
Employer Name:
Trading Name:
Registration Nr:
Nbcrfi Registration Nr:
               Vat Registration:
Legal Status:
Union Code:
Contact Person:
Number of Logins:
Telephone Nr:
Fax Nr:
Postal Address
PO Box/Bag:
Postal Address
Local / City:
Postal Address
Post Code:
Physical Address
Street Name & No:
Physical Address
Building Name & Office No:
Date Registered:   dd-mm-yyyy
Enter Nr sequence:
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