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* Indicates required question
Naam (Name)
*
Your answer
Voornaam (First name)
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Your answer
Geslacht (Sex)
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Man (Male)
Vrouw (Female)
Geboortedatum (Date of birth)
*
MM
/
DD
/
YYYY
Geboorteplaats (Place of birth)
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Your answer
Woonplaats (Residence)
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Your answer
Hoogste genoten Opleiding (Highest level of Education)
*
Your answer
Tot welke etnische groep rekent u zichzelf? (What is your ethnicity?)
*
Creool (Creole)
Hindostaan (East Indian)
Marron (Maroon)
Javaans (Javanese)
Inheems (Amerindian)
Other:
Hoeveel kinderen heeft u die jonger dan 18 jaar zijn? (How many children do you have who are younger than 18 years?)
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Your answer
Telefoonnummer (Phone number)
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Your answer
E-mailadres (Email address)
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Your answer
Beroep (occupation)
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Your answer
Burgerlijke staat (Marital status)
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Getrouwd (married)
Alleenstaand (single)
In een relatie, maar niet samenwonend (In a relationship but not living together)
Gescheiden (Divorced)
Other:
Heeft u huisdieren? (Do you have domestic animals)
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Ja (yes)
Nee (no)
Zo, ja welke huisdieren? (If yes, which ones?)
Honden (dogs)
Katten (cats)
Vogels (birds)
Other:
Clear selection
Rookt u? (Do you smoke?)
*
Ja (yes)
Nee (no)
Welke talen spreek u vloeiend? (Which languages do you speak fluently)
*
Engels (English)
Nederlands (Dutch)
Sranantongo
Spaans (Spanish)
Other:
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