Matrimonial Registration Form

First Name (required)

Last Name (required)

Marital Status (required)

Age (required)

Height (required)

Weight (required)

Complexion: Very Fair/Fair/Wheat/Dark (required)

Born and brought up in CA,USA, Europe (required)

If no, Number of years in CA, USA, Europe

Smoker Status (required)

Wears Hijab (required)

Country of Residence (required)

Status in North America (required)

Educational Qualifications (required)

Occupation (required)

Place of Employment (required)

Years in Service (required)

Mom's Phone Number (required)

Own Cell Number

Your Email (required)

Street Address

City

Postal or ZIP Code

Father's Name (required)

Father is alive

Mother's Name (required)

Mother is alive

Brothers (required)

Sisters (required)

Number of children from Previous Marriage if applicable (required)

Legal Responsibility (required)

Religion (required)

Religious Affiliation or FIQH (required)

Cast (optional)

Mother Tongue (required)

Anything you would like your potential spouse to know about you

Your preferences in your potential spouse (required)

Your current Photograph (required)

Are you PAKSEANA member (required)

1 Comment

  • pakseana

    Mar 06, 2017

    Pakseana Matrimonial Services will not be directly or indirectly responsible for any kind of conflict arising between parties during or after any marriage which takes place as a result of introduction through our services.