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FIRST NAME: ____________________________________

LAST NAME: ____________________________________

DATE OF BIRTH: [DD/MM/YY] [______]

MERRITAL STATUS: a) SINGLE |_| b) OTHER |_|

RELIGION : ____________________________________

NUMBER OF CHILDREN: |_|

MAILING ADDRESS:

_______________________________________________________

_______________________________________________________

_______________________________________________________

HEIGHT (cm): [______]

WEIGHT (kg): [______]

COLOUR OF EYES: a) BLUE |_| b) GREEN |_|

c) BROWN |_|

COLOUR OF HAIR: a) BLONDE |_| b) RED |_|

c) DARK |_|

COLOUR OF SKIN: a) WHITE |_| b) LIGHT BROWN |_|

c) DARK BROWN |_|

EDUCATION: a) PRIMARY |_| b) SECONDARY |_|

c) UNIVERSITY |_| d) OTHER |_|

EMPLOYMENT: a) EMPLOYED |_| b) UNEMPLOYED |_|

c) STUDENT |_|

JOB (eg. CLERK) : ________________

HOBBYS: a) SPORT |_| b) MUSIC/SINGING |_|

c) COOKING |_| d) READING |_|

e) FILM/MOVIE |_| f) NATURE/WALK |_|

CHARACTER: a) HONEST |_| b) ENERGETIC |_|

c) LOVING |_| d) UNDERSTANDING |_|

e) FAITHFULL |_| f) SENCERE |_|

g) SENSE OF HUMOR |_| h) ROMANTIC |_|

i) (other) ________________

SMOKING a) HEAVY |_| b) SOCIAL |_|

c) NON-SMOKING |_|

DRINKING a) HEAVY |_| b) SOCIAL |_|

c) NON-DRINKING |_|

AGE: MINIMUM AGE: |_||_| MAXIUM AGE: |_||_|

MERRITAL STATUS: a) SINGLE ONLY |_| b) DEVORCED OK ? |_|

CHILDREN: a) NO CHILDREN |_| b) CHILDREN OK ? |_|

RELIGION : ____________________________________ (eg. ANY RELIGION)

HEIGHT (cm): MINIMUM HEIGHT: |_||_||_| MAXIMUM HEIGHT: |_||_||_|

WEIGHT (kg): MINIMUM WEIGHT: |_||_||_| MAXIMUM WEIGHT: |_||_||_|

COLOUR OF EYES: a) BLUE |_| b) GREEN |_|

c) BROWN |_| d) ANY COLOR |_|

COLOUR OF HAIR: a) BLONDE |_| b) RED |_|

c) DARK |_| d) ANY COLOR |_|

COLOUR OF SKIN: a) WHITE |_| b) LIGHT BROWN |_|

c) DARK BROWN |_| d) ANY COLOR |_|

EDUCATION: a) PRIMARY |_| b) SECONDARY |_|

c) UNIVERSITY |_| d) ANY EDUCATION |_|

EMPLOYMENT: a) SELF EMPLOYED |_| b) PROFESSIONAL |_|

c) STUDENT |_| d) ANY JOB |_|

HOBBYS: a) SPORT |_| b) MUSIC/SINGING |_|

c) COOKING |_| d) READING |_|

e) FILM/MOVIE |_| f) NATURE/WALK |_|

CHARACTER: a) HONEST |_| b) ENERGETIC |_|

c) LOVING |_| d) UNDERSTANDING |_|

e) FAITHFULL |_| f) SENCERE |_|

g) SENSE OF HUMOR |_| h) ROMANTIC |_|

i) (other) ________________

SMOKING a) HEAVY |_| b) SOCIAL |_|

c) NON-SMOKING |_|

DRINKING a) HEAVY |_| b) SOCIAL |_|

c) NON-DRINKING |_|

** PLEASE WRITE ABOUT YOURSELF AT THE BACK OF THIS FORM BEFORE YOU SEND THE FORM !