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I hereby certify that the answers given by me to the foregoing questions and the statements made are true and correct, without mental reservation whatsoever. I understand that falsely filling out this application in whole or in part will be considered sufficient reason for discharge. I further understand that this application does not bind Pan American-Grace Airways inc. in any way but is merely a means for obtaining information. Signature______________ REMARKS AND ANY OTHER INFORMATION THAT YOU WISH TO GIVE (not to be filled by applicant) Interviewed by _________ Date ________ Action taken __________ Remarks