REGISTRATION FORM - Date Mate
(All fields marked
*
are mandatory)
*
Name:
*
NRIC:
*
Contact No (HP):
*
Email
Address:
*
Address:
*
Date of
Birth:
/
/
*
Occupation:
*
Gender:
Male
Female
*
Name of person you're
interested in dating:
*
Contact of person you're
interested in dating:
*
Attach a recent photograph of Yourself
(500 x 500 pixels, .jpg format and less than 100kb only)
I hereby agree to the following Terms and Conditions
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