Children (age and gender):
Want Children:Yes, I want to have childrenNo, I don't want to have childrenMaybe
Smoker:No, I don't smokeYesSometimes
Describe the person you might be interested in meeting?
What would someone notice first about you?
How might others best describe you?
If you could choose the ideal friend, what would he/she be like?
Which virtues give you the most of your self-confidence?
If you could change one thing about yourself, what would it be?
What personal habits of others irritate you?
What would you like to do that you have never had the opportunity to do?
What do you do to stay in shape?
What type of work do you do and do you enjoy it?
Your current living situation is?
Is religion a part of your life?
What is your favorite outdoor activity?
What is your favorite indoor activity?
What is your favorite type of music?
What type of food do you enjoy the most?
What types of movies do you like the best?
The below client background information is required under the International Marriage Broker Regulation Act of 2005. If you answer "Yes" to any of the questions below, please provide a detailed statement of explanation and information.
Do you have:
Any temporary or permanent civil protection order or restraining order issued against you?NoYes
If yes explain:
Any Federal, State, or local arrest or conviction for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking?NoYes
Any Federal, State, or local arrest or conviction for
a. solely, principally, or incidentally engaging in prostitution;
b. a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution; or
c. receiving, in whole or in part, of the proceeds of prostitution.
Any Federal, State, or local arrest or conviction for offenses related to controlled substances or alcohol.NoYes
Marital history are you currently married?NoYes
Were you previously married?NoYes
If yes explain how many times, how the previous marriages were terminated and the date of termination, and whether you have sponsored an alien to whom you were engaged or married:
List all states and countries in which you have resided since 18 years of age:
By sending this document to us you are certifying and attesting under penalty of perjury and false statement, that my above INFORMATION IS TRUE AND COMPLETE. I also give my permission to International Introductions to release and provide this information in any format to all interested foreign ladies available. I have provided any necessary additional truthful documentation to all questions answered 'Yes' above. I hereby waive any privacy rights from release of this information. I also hereby release and hold harmless and forever discharge International Introductions from any and all liabilities arising from my release of this information and any use of it, and arising from any and all company services, offerings, benefits and assistance.
Please review Pricing & Services and place purchase prior to completing this questionnaire. After sending questionnaire please email pictures to email@example.com.