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: