www.bishopcharlesandcaroldatingandmarriageagency.org: Personal Data Form

	Main
	Facilitators
	Contact
	This agency is not for liars!
	Who can Partcipate:
	Feedback
	What makes this agency biblical?
	Why you have to pay for Services
	Need for this Agency
	How we Operate
	During Courtship
	Agency Registration
	Personal Registration
	This is Legal

Personal Data Form

Bishop Charles and Carol Dating and Marriage Agency

Personal Registration Form
(Strictly Confidential)

Agency Registration Form
Personal Data Form
Medical & Educational Data Form

Surname
Name
Contact Address
E-mail Address
Contact phone number(s)
Occupation
How do you rate your financial status:	In debt below average Average Buoyant Very buoyant:
Sex:
Height:
Complexion
Age
Hobbies:
Turn on:
Turn off:
Personal weakness(es):
Age:
What weakness do you want this agency to counsel you about
Do you take alcohol or smoke?:
Are you an extrovert or Introvert or in between:
Marital Status: (single, single parent, widowed, divorced):
Office / Business Address:
Office / Business Phone Number(s):
Date of Birth:
Place of Birth:
Hospital of birth:
(please note that you are to attach photocopies of birth certificate)
State of Origin :
Local Govt.:
Name of Village and community:
Permanent Address in your Home town:
Have you had any child before? Yes / No	Yes No
State number, sex and Ages.
Religion:
Name of your Father:
Phone number and Address:
Name of your mother:
Phone Number and Address:
Your Mother's village:
Are you from a Christian Home ?:
Next of Kin:
Choice of desired spouse:
Height of desired spouse:.
Complexion of desired spouse:
Age bracket of desired spouse:
Financial bracket of desired spouse
Educational level of desired spouse:
Status of desired spouse:	widowed single parent completely single Divorced Any of the above
Spiritual attainment of desired spouse:
Mentor :
Which church do you attend:
Church Address:
Position held in church (if any):
Are you a born-Again? (if yes, which year):
Do you speak in tongues:
Any previous broken engagement (if yes, how many)?:
Any recurring dreams you like us to know and pray about: (if any, briefly supply such information here):
Any history of non-marriage or marital instability that we need to pray about?
(if yes, briefly supply such information here):
Your Educational Qualification:

Please click the SUBMIT button only once, then allow a few minutes for this process to be completed. Clicking more than once may result in repeated transactions.