First name

Name

Date of birth

Age

Growth

Weight

Mark of the zodiac

Citizenship

Education

Creed

Trade

Children

Knowledge of languages

Shortly about itself

Wish to the partner

The address of electronic mail

The post address

The complete post contact or home address is necessary for service usage. To disclosure is not subject.

On the questionnaire apply colour photos on a light background.

The filled questionnaire and photos, please, send on the post address: p.o.box 3745, Kharkov, 61177, Ukraine or on the electronic address:

The questionnaire can be sent from our site:

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