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electronic statement must necessarily indicate full and accurate details of the applicant,
clearly, concisely and understandable explain the essence of the raised question

First name *
Surname *
Patronimic *
PostalCode *
Region, district, town *
Street, house, flat *
E-mail *
The social status of the applicant *
Category applicant *
Phone number
Message/question type *
Message/question text *
Type the characters from the picture *
By registering an appeal, I give consent to the processing and use of personal data in accordance with the legislation of Ukraine *