QUESTIONNAIRE - FORM A
(To be filled in by the Applicant in block letters for the information of the Bureau only.)
PHONE NO: LANDLINE______________ MOBILE:______________
NAME OF PARISH:
DATE OF BIRTH:
COUNTY OF BIRTH:
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.)
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.