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The 2nd and 3rd letters of your mothers maiden/family name:

X[ ][ ]___________

The day of the month that your mother was born [01-31]:

The 4th and 5th letters of your fathers middle name,
if his name: is shorter an 5 letters then wrap, e.g. John = "nj"

Xxx[ ][ ]___________     or     Xxx[ ] + [ ]xxx

The day of the month that your father was born [01-31]:

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