First Name * Middle Name Last Name * Meaning of Each Name Special event at Birth (For example were you presented to sun, water, dead ancestors, etc): Are you properly married? Yes No If “No” Please explain ... Do you have children? Yes No Is anyone of them spiritually challenged? Do you read stars? (Derived from cosmic powers) Yes No Do you believe and go to Palm Reader? Yes No Is there any idol being worshiped in your family? Yes No What are forbidden in your family?
Paternal Information Name of Grand Father Meaning of Grand Father’s Name Grand Father’s Religion & terms of worship Name of Your Father Meaning of your Father Name Father’s Religion & terms of worship Any other information about paternal generation
Maternal Information Name of Grand Mother Meaning of Grand Mother’s Name Grand Mother’s Religion & terms of worship Name of your Mother Meaning of your Mother Name Mother’s Religion & terms of worship Any other information about paternal generation: Have you been to a native doctor? Yes No If Yes Please Explain ... Are there curses in the family? Yes No If Yes, Please Write here ? Have you practiced occultism? Yes No If Yes, Please Write here ? Have you been involved (or still active) in any illegal or spiritual sexual acts? Yes No If Yes, please explain here Have you been involved in any sexual perversion? Incest Homosexual Bestialism Masturbation No Are you still in the act of sexual perversion? Yes No If Yes. Please Explain ... Are marriages in the family usually unsuccessful? Yes No If Yes. Please Explain ... Do you have uncontrollable sexual urges or thought? Yes No If Yes. Please Explain ... How is your dream life? (Seeing dead family, engaging sexual acts, etc) Yes No If Yes. Please Explain ... Any form of addiction in the family (Alcohol, drugs, etc)? Yes No If Yes. Please Explain ... Why do you need deliverance?