rectification heure de naissance

My Name*

First NameFamily Name

E-mail*

Confirmation E-mail*

Date of birth*

DayMonthYear

Supposed time of birth (if any)

Hours : Minutes + AM or PM

If Time in unknown, indicate morning, afternoon, evening, night, etc.

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

Were there an important personal events (family, health, or other) during the first year of your life?*

No historical events please

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

Please note that a fee of 75€ applies for this service. Thank you

Payment only by bank transfer until further notice

Bank Transfer

Birth Time rectification