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Date of Birth:	1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 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
Occupation
Income	Please Select.. Below 10,000 10,000-15,000 15,000-20,000 20,000-25,000 25,000-30,000 Above 30,000
Homeowner	Please Select.. Yes No
Hold shares	Please Select.. Yes No
Total worth of portfolio	Please Select.. 0-25,000 25,000-50,000 50,000-75,000 75,000-100,000 100,000 or more
Do you hold and Unit Trusts or Investment Trusts	Please Select.. Yes No
Do you hold any ISAs:	Please Select.. Yes No
Total worth of ISAs
Private Pension:	Please Select.. Yes No
Overseas Property Owner	Please Select.. Yes No
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