Phone:
+44 (0) 1753 538 508
Email:
info [AT] laj.co.uk
General
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Registration
Sample Members
Fri 24 May, 2013
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.
Personal Service
for 12 months
I am sending the registration fee of
GBP £275
for 12 months' membership.
I understand that the fee made above is 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
Terms And Conditions
Registration Form
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