Blessing Application                             Applicant No

                                      1) Family Name :		                                         First Name:

           Photo                 2)  The country you live now:                                       3) Nationality:

		         4) Sex:			5) Date of Birth:			  6) Spiritual Birthday:
						     year      /    month   /    day  	       year    /   month   /   day
 		          Male   O    Female   O

7) Academic Background code:                             8) Height :                           Cm          9) Weight :                       Kg

10) Blood type: 		11) Local FFWPU Location:		          12) FFWPU Tel No:

13) Occupation:  	           14) Tel No.:  __________________________
                                                         Address: _________________________________________________________________
                                                         Email:  ____________________________________________________________________________
15) Current Martial Status:      Single  O              Married  O 	   Divorced   O           Widowed   O

      Have you ever lived with someone outside of marriage?      Yes   O     No  O     If Yes, For how long? ________

      Number of the children:   Sons  (          )         Daughters   (          )        None  O
 
16) Previously Blessed? 	 Yes  O    No  O           If Yes, What blessing group?   (			Couple)
      Did you Complete the 3-day Ceremony?  Yes O   No  O    Number of Blessed children:  Sons (       )  Daughter (       )

17) AIDS:   HIV Positive  O    HIV Negative  O       18) Sickle Cell :  Negative O      Carrier  O      Anemia  O

19) Describe any serious problem:  Yes  O  No  O    If Yes, You must submit a separate sheet of paper describing
      the problem detail.

20) Remarks:

I agree with Teachings of the “Family Federation for World Peace and Unity ” to establish a world peace through the ideal of true family. I wish to become a member of the FFWPU in the 400 Million-Couple Blessing. 

I certify the above to be true, and pledge to follow all the preparations, ceremonies and directions of the Blessing Ceremony.

Date: ________________________________ Signature: _______________________________________________

Signature of the local FFWPU representative: __________________________________________________________

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