B B B B B B B B B B B B B B: Day/Month/Year Day/Month/Year
B B B B B B B B B B B B B B: Day/Month/Year Day/Month/Year
B B B B B B B B B B B B B B: Day/Month/Year Day/Month/Year
Item: Date:
10. Mark the sequence of births in your family.
Please cross B for brother or S for sister
B B B B B B B B B B B B B B
Person
elder siblings younger siblings
himself
S S S S S S S S S S S S S S
d) B S e) B S f) B S
Day/Month/Year Day/Month/Year Day/Month/Year
11. Highest educational degree:
Subject: Date:
Day/Month/Year
Break in education: From: To:
From: To:
3. Major illnesses, hospitalizations, surgeries, accidents: Specify the part of the body diseased or injured and the cause, like
diabetes or car accident etc.
a) from: to:
Day/Month/Year Day/Month/Year
b) from: to:
c) from: to:
d) from: to:
Son Daughter
Son Daughter
Son Daughter
Item: Date:
10. Mark the sequence of births in your family.
Please cross B for brother or S for sister
B B B B B B B B B B B B B B
Person
elder siblings younger siblings
himself
S S S S S S S S S S S S S S
d) B S e) B S f) B S
Day/Month/Year Day/Month/Year Day/Month/Year
11. Highest educational degree:
Subject: Date:
Day/Month/Year
Break in education: From: To:
From: To:
3. Major illnesses, hospitalizations, surgeries, accidents: Specify the part of the body diseased or injured and the cause, like
diabetes or car accident etc.
a) from: to:
Day/Month/Year Day/Month/Year
b) from: to:
c) from: to:
d) from: to:
Son Daughter
Son Daughter
Son Daughter