海外匯款回報表單 Overseas Remittance Declaration Form
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就診客戶夫妻雙方姓名 (Full Names of Both Spouses Receiving Medical Treatment) *
就診客戶ID (ID Numbers of Both Spouses Receiving Medical Treatment)
 *
就診太太出生年月日( Date of Birth of the Female Patient (YYYY/MM/DD)) *
MM
/
DD
/
YYYY
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