Name	Sex -select- male female
Date of Birth	dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC yyyy 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
e-mail no :
Time of Birth	hh 0 1 2 3 4 5 6 7 8 9 10 11 12 hours mm 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 minutes am/pm AM PM
(Use only standard time. DST may not be used)
Country of Birth	-select one- Afghanistan Albania Algeria Andorra Angola Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bhutan Bolivia Borneo Bosnia & Herz. Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Is. Cen. Afr. Rep. Chad Chile China Colombia Comoros Congo Dem. Rep. Cook Is. Costa Rica Cote D' Ivoire Croatia Cuba Cyprus Czecho Denmark Dominican Rep. Ecuador Egypt Eq. Guinea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guatemala Guiana Guinea Guinea-bissau Guyana Haiti Hnduras Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Java Jordan Kazakhistan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Macedonia Madagascar Madeira. Maderia Malawi Malaysia Maldives Mali Malta Malwi Marshall Island Martinique Mauritania Mauritius Medagascar Mexico Micronesia Moldova Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Nishpur North Korea North Marianasch Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Quatar Rep Of Djibouti Rep. Of Ireland Romania Russia Rwanda S Africa Saint Lucia Samoa Sao Tome & E-pri Saudi Arabia Senegal Sierra Leone Slovenia Solomon Is. Somali Rep. Somalia South Africa South Korea Spain Sri Lanka St. Kitts-nevis St. Vin. & Gren. Sudan Sumatra Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad &tobago Tunisia Turkey Turkmenistan Tuvalu U.A.E. U.K. U.S.A. Uganda Ukraine Uruguay Uzbekistan Venezuela Vietnam Virgin Is. (uk) West Sahara Yap Yemen Yugoslavia Zambia Zimbabwe
Place/City of birth(Nearest)	-select-
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