ABOUT YOURSELF

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Initials *
Surname *
Date of Birth *	day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 month January February March April May June July August September October November December year 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
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Fill in your cellphone number and at least one contact number **
Home telephone number **
Work telephone number **
Cellphone number *
Email address
Your mother's maiden name *

AFFORDABILITY INFORMATION

Total monthly income 1 + 2 + 3 1. Monthly income before deductions * 2. Spouse/partner monthly income before deductions 3. Other monthly income e.g. allowance, comm, maintenance, bonuses etc.

Total monthly expenses 4 + 5 4. Monthly credit commitments e.g. bond on home, car,clothing/furniture/cell phone accounts etc. * 5. Other monthly expenses e.g. tax, medical aid, pension, rent, electricity, water, food, transport, school fees, etc. *

UPDATES AND NOTIFICATIONS

May we send you information on the latest fashion, special offers, and exclusive invitations from Truworths via:

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If you do not indicate your personal preferences to the marketing and third party questions below, we will continue to use these practices until you advise otherwise.

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