FILL-IN-FORM FOR PARTNERS (PARTNER VAN ZEGGENER)
AND
CHILDREN (WITH A MOTHER NAMED VAN ZEGGEREN)

FAMILYNAME
FIRST NAME(S)
DATE OF BIRTH
PLACE OF BIRTH
COUNTRY OF BIRTH
SEX
male female
ACTUAL ADDRESS
ACTUAL PLACE OF LIVING / COUNTRY
@MAIL AND TELEPHONENUMBER
@mail 

tel:

PROFESSION
NAME FATHER
(name, first name(s))

DATE OF BIRTH FATHER
NAME MOTHER (name, first name(s))
DATE OF BIRTH MOTHER
MARRIED WITH / LIVING TOGETHER WITH (name, first name(s)   sex , date of birth)
CHILDREN (name, first name(s), sex, date of birth)
SPECIAL INFORMATION
(IF DEAD: PLEASE INFORM ME ON DATE AND PLACE)
INFORMATION GIVEN BY (name, @mail)
name:

@mail:

I AGREE WITH  THE PUBLICATION OF THIS INFORMATION ON THE INTERNET-SITE

 yes        no