Laj Logo Laj Marriage Bureau International -- Marriage Specilists -- Dating Experts Phone: +44 (0) 1753 538 508
Email:  info [AT] laj.co.uk
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| General | Advertisements | Registration | Sample Members | Fri Sep, 01:42:36 |
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Registration Form (Confidential)
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Please complete this form as accurately as possible (either by hand or
type in your details), then post it along with the appropriate fee stated.

Fields in BOLD (with *) are compulsory

If filling in by hand in ink write clearly in CAPITAL letters

Please attach applicant's recent photograph if readily avaiable. Large size photo is also welcome

APPLICANT'S PARTICULARS

Title:* Mr   Mrs   Miss   Dr Surname:*
Gender:* Male   Female   Forename(s):*
Email Address:*
Home/Residential Address:* Job/Self Employment Address:
   
   
   
Post/Zip Code:* Post/Zip Code:
Phone No:* Phone No:
Can We Contact:* Yes No Can We Contact: Yes No
Date of birth:* Any Physical Defects:
Height:* Weight:
Complexion:* General State
Of Health:
Religion:* Caste:
Country Of Birth:* Nationality:
Marital Status:* Single   Divorced   Widow   Widower   Separated  

Any children (with sex and ages) and in whose custody:

Education, with special qualifications, if any (say 'School Standard' if none):*
Occupation:*
Do you drink?:* Yes   No Income:
Do you smoke?:* Yes   No Do you own a vehicle?: Yes   No
Are you vegetarian?:* Yes   No Do you own property?: Yes   No
Where did you hear about
Laj Marriage Bureau?		 Search Engine   Newspaper   Recommendation   Other
  Please Specify

APPICANT'S FAMILY PARTICULARS

Father's name:* Alive:* Yes   No
Mother's name:* Alive:* Yes   No
How many do you have? Brothers:* Sisters:*
How many unmarried? Brothers:* Sisters:*

DESIRED PARTNER YOU WISH TO MEET

Age range:* Height range:*
Religion:* Caste:
Nationality:*    
Would you accept a:* Widow   Widower   Divorced   Separated Partner
With or without children:
Additional Details (if any):

DECLARATION BY APPLICANT/PARENTS, ETC

I declare that to the best of my knowledge, the particulars given above are true.
I have read and understood the Terms and Conditions and will abide by them.
I am joining the following service as ticked by me.
Personal Two Fee Service
(18 months)
  • I will send the registarion fee of £275.
  • I also undertake to pay £150 as Marriage Settlment Fee within 7 days of Registration of Marriage.
Personal One Fee Service
(18 months)
  • I will send the registarion fee of £325.
  • I owe nothing after the marriage as there is no Marriage settlement fee.
I understand that all the fees made above are neither refundable nor transferable.
Today's Date
Signed by hand
Full name and relationship if signed by other than the Applicant
Cheque/Postal Orders should be made payable
to:            LAJ MARRIAGE BUREAU 		Post to:     LAJ MARRIAGE BUREAU
                137 Goodman Park
                Slough (Berkshire) SL2 5NR
                England
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