Paternal Questionnaire

Paternal Questionnaire
In order to confirm our research and to assist us in contacting other possible beneficiaries, please complete this questionnaire to the best of your knowledge, but without incurring expense.
Case Reference Number*
Please find this reference within your enclosed letter
Client Reference Number*
Please find this reference within your enclosed letter
Date

DayMonthYear
- Full Name
  
  PrefixFirst & Middle Name(s)Surname
- Telephone Number
- Email
  example@example.com
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Name at Birth
- Have you ever been bankrupt?
- If your name has been changed by marriage or otherwise, please provide us with your spouse's full first name(s) and surname, together with the date and place of your marriage
- If you have been married more than once, please provide details of these other marriages, with dates and place and date of divorce (if applicable)
- Father
- Full Name
  
  First & Middle Name(s) Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Date of Death
  
  DayMonthYear
- Place of Death
- Mother
- Full Name
  
  First & Middle Name(s)Maiden Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Date of Death
  
  DayMonthYear
- Place of Death
- Date of Parents Marriage
  
  DayMonthYear
- Place of Parents Marriage
- If your father was married more than once, please provide details of other marriage
- Please fill in details about ALL your FULL BLOOD siblings. If you have more than 3, please use the continuation section below to add in any others.
- SIBLING 1
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- SIBLING 2
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- SIBLING 3
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- If any brothers and sisters have died, please provide dates and place of death, along with their name at death
- If any of your deceased brothers or sisters left children (your nephews or nieces), please provide us with their name(s) and address(es)
- Continuation Section
  Please use this section if required to add any further information
- If your father had other children by a different mother (your half brother(s) and sister(s)) or adopted any children, please provide their details below. Please use the continuation section below if required.
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Adopted?
- Relationship to you
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Adopted?
- Relationship to you
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- Continuation Section
  Please use this section if required to add any further information
- Please provide details of all your FATHER'S siblings. Please use continuation section below, if required.
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Relationship to you
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Relationship to you
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- Full Name
  
  First & Middle Name(s)Surname
- Date of Birth
  
  DayMonthYear
- Place of Birth
- Telephone Number
- Passed away?
- Date of Death
  
  DayMonthYear
- Place of Death
- Relationship to you
- Address
  
  Address Line 1
  
  Address Line 2
  
  CityState / Province / County
  
  Postal / Zip CodeCountry
- If any of your paternal uncles and aunts have died, please state when and where they died, along with their name at death
- If any paternal uncles and aunts mentioned above died leaving children (your paternal cousins), please gprovide their names and addresses. Please confirm which deceased uncle/aunt they are the child of
- Should any of the paternal cousins mentioned above, died leaving children, please give their names and addresses
- Continuation Section
  Please use this section if required to add any further information
- If you have any other information that you think may be of help, or details of your paternal grandparents, please make use of the space below.

Paternal Questionnaire

Father

Mother