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. Messaging app
(not displayed on the web-site)
Skype(XXX), WhatsApp(XXX), Viber(XXX), etc.
4. E-mail
(not displayed on the web-site)
5. Date of Birth
(only year of birth is displayed on website)
Year
/Month
1
2
3
4
5
6
7
8
9
10
11
12
/Day
1
2
3
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5
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14
15
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31
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.
Agree with the terms and conditions and privacy policy
