rectification heure de naissance

My Name *

First Name Family Name

E-mail *

Confirmation E-mail *

DATE OF BIRTH (day / month / year) *

DAY / MONTH / YEAR

Time of birth known

morning, afternoon, evening or night

Origin of the above information (mother, birth certificate, other source)

Place of birth *

Town, country and all relevent information

Was your birth assisted (cesaerian, forcepts or else) *

Be as specific as possible

Was there an important event during the first year of your life? *

If yes, describe

Are you married? *

Yes/No

Are you divorced? *

Yes/No

Is your partner deceased? *

Yes/No

If Yes, when did it happen and how?

Accident, illness, etc.

Are your parents divorced or separated? *

Yes/no

How is/was your parents' relationship? *

Explain how you feel about them

How was/is your relationship with your mother? *

If no relationship, explain why

How was/is your relationship with your father? *

If no relationship, explain why

Do you leave far from place of birth? *

Yes/no

Tell us about an important event, with date and place if known *

Illness, accident, loto win, any type of important event

Any accident (car or other type)? *

YEs/No

Describe the event/s and provide date/s and place/s *

Circumstances and consequences

Any surgery? *

Yes/No

Describe and explain the outcome *

Consequences

Any chronic health problems? *

Describe and explain (since when, why, etc.)

Any major illness? *

Describe and explain

What is/was your profession? *

Describe

What profession would you have liked to do instead of the above answer? *

Describe and explain why you haven't succeeded

Other events or important information that may help work out your time of birth *

Dates + descriptions

A fee of 75€ applies for this service. A PayPal invoice will be mailed to you if payment is due. If you prefer to pay by bank transfer, let me know and I'll email you my account details.

Thank you

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Birth Time rectification