fill in van zeggeren

FILL-IN-FORM FOR ALL PERSONS NAMED
VAN ZEGGEREN OR BORN WITH THE NAME VAN ZEGGEREN

FAMILYNAME	VAN ZEGGEREN
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

FIRST NAME(S) FATHER (+ please fill in a new form on his name)	VAN ZEGGEREN
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) + please fill in a new form for each child born with the name VAN ZEGGEREN

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