Irbis Marriage Agency
Irbis Marriage Agency

Registration Form

●Inquiry over the phone
TEL:+81 3 6869 5409
Weekdays/10:00~20:00
Saturdays/10:00~13:00
Closed on Sundays and public holidays

Please fill in the information about yourself.

1. Name (not displayed on the web-site)
2. Tel (not displayed on the web-site)
3. Skype (not displayed on the web-site)
4. E-mail (not displayed on the web-site)
5. Date of Birth (only year of birth is displayed on website)
Year /Month /Day
6. Nationality
7. Place of residence
8. Height
cm
9. Weight
kg
10. Educational background
11. Job
12. Foreign Languages & Proficiency level (fluent, intermediate, beginner)
13. Marital status
  • Never been married
  • Divorced
  • Widow
14. Do you have children?
  • Yes
  • No
15. Children details (date of birth, gender)
16. Personal characteristics (character, hobbies, etc.)
17. Partner preferences (age, height, character, etc.)
18. Photos and a copy of passport
1.
2.
3.
4.
5.
6.

Before you sign up, please carefully read our terms and conditions and privacy policy.
If you agree with it, please check the box below.