Bedrijfsnaam   (b.v. Google, Inc.)

Identificatienummer^* (SOFI nummer)

Voornaam^* (b.v. Jack)

Achternaam^* (b.v. Daniels)

Adres^* (b.v. Hoogstraat 15)

Adres (regel 2)   (b.v. Kantoornr.)

Postcode^* (b.v. 1000 AA)

Plaats^* (b.v. Amsterdam)

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Provincie^* -

Telefoon thuis^* (b.v. 06-52000001)

Mobiele telefoon   (b.v. 06-52000001)

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