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Request for statistical data

1) The fields with an asterisk must be filled in
2) Your request will be forwarded to service.statistiques[a]etnic.be and will be handled by the competent person.
 

Step #1. Your personal data Step #2. Your request Step #3. Send...
Status *: Public institution (to be specified)   
Private person / non-profit organisation
Or other (to be specified)   
 
Denomination or name:  *
 
Address: Street:  *    N°:  
CP:  *    Locality:   *
Country:   (by default : Belgium)
 
 
 
E-mail/site: E-mail:  *
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