Name:

Nickname:

Male/Female:

Date of Birth:

Your Sign:

Birthplace:

Citizen for which Country?

Age:

Age you pass for:

Which Languages do you Speak?

Color of Hair:

Color of Eyes:

Height:

Weight:

Single

Yes

No

Divorced

Yes

No

Widowed:

Yes

No

How long?

How long?

How long?

Close to your family?

Yes

No

Your parents are from:

Are they together?

Yes

No

How many children do you have?

Do they live with you?

Yes

No

Custody arrangement

Their names and ages:

I want a:

Marriage

Long Term Relationship

Just a Date

Companion

Start a Family

Occupation:

Net Worth:

Annual Income:

Education Level:

Name of School/College:

Year Graduated:

Hobbies:

Your goals

Do you smoke?

Yes

No

I want a

Smoker

Nonsmoker

Are you religious?

Yes

No

Are you spiritual?

Yes

No

I prefer this religion

Do you want to know your date’s feedback about you?

Yes

No

Describe your looks and personality:

What do you have to offer your mate?

Do you own/rent/lease a House/Condo/Apartment?