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First name:
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Date of birth:
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I confirm that the above information provided by me is true and accurate. I have read and hereby agree to the terms and conditions of the QuotePalm Membership operated by Quote Palm, which shall be binding on me.

I further acknowledge that in order to proceed with the membership application, registration and/or subscription and the provision of services, benefits and privileges related to the Quote Palm membership, the sharing, transfer, retrieval, updating and processing of my personal information and data as well as creation of member profile and user accounts may occur between Quote Palm respective group companies, related corporations, affiliates, subsidiaries, associates and I confirm that I have read Quote Palm’s Privacy Policy and consent to the processing of my personal data for purposes of the same.

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