Document 6570727

Marriage Application Form
On the occasion of Christmas Puja, Ganapatipule, 2014
Please fill out form in full. If details are not complete, your application may not be accepted. Fill out in duplicate (x2). Local
Coordinator to retain a copy for future reference.
Title:
Surname:
First Name:
Nationality
Passport No:
Date of Birth
Age:
DD/MM/YYYY
Height:
Weight:
Feet & Inch
in Kg
Complexion:
Physical Status & any Health problems/disabilities/mental illness:
Marital Status:
Children:
Number of Boys & Girls / Living together / separated
Which SahajaYoga Center you are regularly attending for last 2 years:
Date of Realization:
Please affix color
passport type
photograph on each
copy
Languages spoken: (Please indicate level of fluency: A = native fluency; B = fluent; C = conversational; D = elementary)
Education In detail:
Dates: From-To
Your Occupation & Name of Organization you work for:
Qualifications/Grades:
Annual Income: In Indian Rupee
INR.
Family Type:
Joint / Nuclear
Your Previous seeking History or Religious Background:
Your Interests, Skills & Hobbies:
Home Address:
Flat/Plot no:
Building Name:
Town/City:
Phone no:
Include Area Code
Street/Road:
State:
Pin code/Zip Code:
Country:
E mail:
What ties or Commitments do you feel you have towards family:
Please indicate the occasions of any previous application for SahajaYoga marriage and why it was not solemnized:
Are you willing
YES/ NO
to change country?
Are you legally
YES/ NO
Free to marry?
Applicant’s signature:
Signature
Are you coming
YES/ NO
to GP Seminar?
Date:
DD/MM/YYYY
Signature of Centre/City/State/Country Coordinator
I certify this person’s application
FULL NAME
Signature
Date:
DD/MM/YYYY
Phone Number:
Include Area Code
Email: __________________________________________
Divorcees must submit a copy of the legal document before the marriage registration. Any conditional requirements must be specified on this form. Write on reverse if necessary.
Applicant must submit a copy of educational certificates & salary certificate from employer or IT returns, wherever applicable, in support of above.
Is there any history of genital herpes, incest or criminal behavior in the family?
YES / NO Insert Details
Is there any history of homosexuality / bisexuality? (This applies to women as well as men).
YES / NO Insert Details
Any risk of HIV?
YES/ NO
Any history of intravenous drug use?
YES/ NO
Did you had a HIV Test? If “Yes” what was the result?
YES/ NO Insert Details
Reference of three (3) SahajaYogis/Yoginis is provided below:
Sr. No: Full Name:
Place: City/Country
Contact Number & Email
I hereby declare that all the information provided in this form is true.
Applicant’s signature:
Signature
Date:
DD/MM/YYYY
Consent of Parent/Guardian
FULL NAME
Signature
Date:
Phone Number:
DD/MM/YYYY
Include Area Code
Email:________________________________________
For Office Use Only:
Our observations on the basis of Candidate interview / Reference check / Confidential form: