Report of birth |

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First name *

Last name *

Middle name *

Suffix name

Alias *

Age *

Birth date *

Gender *

Street *

House number

Floor

Unit

Building name

Compound name

Your phone number *

Your photo (2x2 or Selfie) * Accepted formats: jpg, png, pdf. max size: 5mb

Valid id * Accepted ids: government id, passport, drivers license, etc. max size: 5mb

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