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? YesNo
If “No” Please explain ...
Do you have children? YesNo
Is anyone of them spiritually challenged?
Do you read stars? (Derived from cosmic powers) YesNo
Do you believe and go to Palm Reader? YesNo
Is there any idol being worshiped in your family? YesNo
What are forbidden in your family?
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
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? YesNo
If Yes Please Explain ...
Are there curses in the family? YesNo
If Yes, Please Write here ?
Have you practiced occultism? YesNo
Have you been involved (or still active) in any illegal or spiritual sexual acts? YesNo
If Yes, please explain here
Have you been involved in any sexual perversion? IncestHomosexualBestialismMasturbationNo
Are you still in the act of sexual perversion? YesNo
If Yes. Please Explain ...
Are marriages in the family usually unsuccessful? YesNo
Do you have uncontrollable sexual urges or thought? YesNo
How is your dream life? (Seeing dead family, engaging sexual acts, etc) YesNo
Any form of addiction in the family (Alcohol, drugs, etc)? YesNo
Why do you need deliverance?
