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[{"$nulls":5},"FSP 44595"]
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["Kliënt",null,null,null,"Polis No :   "]
[]
["Bemarker",null,null,null,"Aansoek datum:"]
[]
["Versekeraar"]
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[{"$nulls":4},"ONTVANG:"]
[null,1,"Makelaar openbaarmaking",null,null,"Kliënt handtekening:"]
[null,2,"Magtigings Brief  & Makelaars aanstelling"]
[null,3,"Algemene Kliente behoefte ontleding"]
[null,4,"Klient Advies rekord",null,null,"Kliënt handtekening:"]
[null,5,"Behoefte Analiserings vraelys"]
[null,6,"Klient beleggings behoefte analise & risiko profiel"]
[null,7,"Klient ontleding"]
[null,8,"Kwotasie"]
[null,9,"Fund fact sheet"]
[null,10,"Aansoek"]
[null,11,"Fica  Dokumente"]
[null,null,"11.1 FICA Verklaring"]
[null,null,"11.2 Bewys van ID"]
[null,null,"11.3 Bewys van adres"]
[null,null,"11.4 Bewys van Bank besonderhede"]
[]
[]
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[null,null,"Opmerking","______________________________________________________________________________________"]
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[null,null,null,"______________________________________________________________________________________"]
[]
[]
[null,null,"Toesighouer:","______________________","Bemarker :          ___________________"]
[]
[]
[null,null,"Handtekening :_____________________",null,"Handtekening:        ___________________"]
[]
[null,null,"Datum:              ________________________"]

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