CIF

Client Information Form
(Biological Father) Intended Parent 1
Prefix
First Name*
Middle Name
Last Name*
Suffix Name
Street Address*
City*
State / Province / Region*
Zip / Postal Code*
Country*
IP 1 Country
Passport Issuing Country*
IP 1 Passport Issuing Country
Passport Number*
Date of Birth*

MonthDayYear
Mobile Number Including Country Code*
Data Mobile Number IP 1
Email*
example@example.com
If USA Citizen, have you had citizenship and also lived in the USA for at least 5 years?*
Data If USA Citizen, have you had citizenship and also lived in the U.S.A. for at least 5 years?
Do you have a spouse/partner you would like to be included in your surrogacy contract?*
Data Do you have a spouse/partner you would like to be included in your surrogacy contract?
Intended Parent 2
Prefix
First Name*
Middle Name
Last Name*
Suffix Name
Passport Issuing Country*
IP 2 Passport Issuing Country
Passport Number*
Date of Birth*

MonthDayYear
Mobile Number Including Country Code*
Data Mobile Number IP 2
Email*
example@example.com
Emergency Contact

In addition to / in place of Intended Parent 2
First Name*
Last Name*
Relationship To Client(s)*
Mobile Number Including Country Code*
Data Mobile Number Emergency Contact
Email*
example@example.com
Emergency Contact will be the same person as Nominated Personal Representative and Guardian
Personal Representative Information

The personal representative will be responsible for making payments in the event of an untimely death of the intended parent(s) and also to secure citizenship, passport(s) and related documents for the intended parent’s child/children.
First Name*
Last Name*
Street Address*
City*
State / Province / Region*
Zip / Postal Code*
Country*
Personal Representative Country
Mobile Number Including Country Code*
Data Mobile Number Personal Representative
Email*
example@example.com
Guardian Information

In the event of the IP’s death or incapacitation, the guardian will serve as the legal guardian of the intended parent’s child/children resulting from this surrogacy program.
First Name*
Last Name*
Guardian's Address is the same as the Personal Representative
Street Address*
City*
State / Province / Region*
Zip / Postal Code*
Country*
Guardian Country
Mobile Number Including Country Code*
Data Mobile Number Guardian
Email*
example@example.com
Please verify that you are human*
Should be Empty:

Client Information Form

(Biological Father) Intended Parent 1

Intended Parent 2

Emergency Contact

Personal Representative Information

Guardian Information