QUESTIONNAIRE - FORM A 
(To be filled in by the Applicant in block letters for the information of the Bureau only.)


SURNAME: Mr./Mrs./Miss


CHRISTIAN NAMES:


ADDRESS:


PHONE NO: LANDLINE______________ MOBILE:______________

EMAIL ADDRESS:


NAME OF PARISH:


DATE OF BIRTH:


COUNTY OF BIRTH:


HEIGHT:


EDUCATION:


NATURE OF EMPLOYMENT OR OCCUPATION:


SALARY/INCOME OF SIZE OF FARM:


INTERESTS, HOBBIES, & PASTIMES:


WOULD YOU DESCRIBE YOURSELF AS A RELIGIOUS PERSON?


PHYSICAL DISABILITIES OR DEFORMITIES, IF ANY:


WERE YOU PREVIOUSLY MARRIED?:


IF YES ARE YOU FREE TO MARRY IN THE CATHOLIC CHURCH?


HAVE YOU CHILDREN?


IF YES; AGES OF CHILDREN:


ANY OTHER INFORMATION ABOUT YOURSELF:

(To help us in our advertising we would like if you would specify how you became aware of the Bureau.)


DECLARATION

I declare that I have read and understood the particulars and conditions of the Bureau and that the information I have given above is, to the best of my knowledge, correct.


I understand that I alone be held responsible for my conduct towards the person or persons to whom the Bureau introduces me.



Signature:__________________________

Date: ______________