Name  *

Age  *

Address  *

Telephone (Office)

Telephone (Home)

Telephone (Mobile)

Email

Occupation  *

Highest Education Level  *

Religion  *

Baptised

Attending church?

If yes,

Marital Status  * Single  Divorced  Widowed 

Have both of you had pre-marital sex?  *  Yes   No 

Have you had previous relationship before?  *  Yes   No 

If yes, what was the reason for the break-up?

Have you had pre-marital sex in your previous relationship?  *  Yes   No 

Courtship Duration  *

Partner's Name  *

Father's Name  *

Father's Age

Father's Religion

Father's Occupation

Mother's Name  *

Mother's Age

Mother's Religion

Mother's Occupation

Your position in family  *

How many siblings in the family?  *