1.Name of Husband/ Wife that is Related to Hakim Family

___________________________________________________________________

Maiden Name ________________________________________________________

First Middle Last

Date of Birth__________________ Place of Birth ____________________________

________________________ City  _____________________ Country

Address______________________________________________Tel.____________

Street City Zip Code

Are you Married? _ Yes _ No If yes go to 2.

2. Name of Spouse that is not Related to the Hakim

___________________________________________________________________

First Last

Date of Birth__________________ Place of Birth ____________________________

City

________________________________

Country

3. Write Down Information Related to your Hakim Family Roots

3.1 Name of Father or Mother Related to the Hakim Family (Of the

Wife/Husband in 1)

First Name______________(Mother/Father) Family Name _____________________

___________________________________________________________________

Date of Birth__________________ Place of Birth ____________________________

City

__________________________________________

Country

3.2 Names of Brother/Sisters of the Mother/ Father Written in 3.1 (Your aunts

and uncles)

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

3.3 Name of Mother or Father of 3.1 Related to the Hakim Family ( Your

Grandparents) :

First Name __________________ Family Name _____________________________

Date of Birth_____________________ Place of Birth _________________________

City

__________________________________

Country

Are they Alive? _ Yes _ No If yes, give their address

____________________

___________________________________________________________________

3.4 Names of Brothers/Sisters of the Mother / Father Written in 3.3

_______________________ ____________________ _______________________

______________________ _____________________ _______________________

If alive, give their addresses below:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Name of Mother/Father of the Hakim Descendant Written in 3.3

First Name__________________ Family Name ______________________________

3.6 Names of Brothers/Sisters of the Mother or Father Written in 3.5

_____________________ _______________________ ______________________

____________________ _______________________ _______________________

4.0 Write the Names of your Brothers and Sisters (Related to the Hakim

Family)

First ___________ Family ___________ First __________ Family ____________

First ____________ Family ___________ First __________ Family __________

First ____________ Family __________ First __________ Family __________

First ____________ Family ____________First _________ Family ___________

5. Write down information about your children, if the son/daughter are

married, write the name of the husband/wife in parenthesis.

First Name______________ Family Name__________________________________

Address ____________________________________________________________

Birth Date _______________ Place of Birth_________________________________

City

Country

First Name______________ Family Name__________________________________

Address ____________________________________________________________

Birth Date _______________ Place of Birth_________________________________

City

Country

First Name______________ Family Name__________________________________

Address ____________________________________________________________

Birth Date _______________ Place of Birth_________________________________

City

Country

6. Write down information about your grandchildren, if your grandson /

granddaughter are married, write the name of husband/wife in parenthesis.

First Name______________ Family Name __________________________________

Father’s or Mother’s Name From Hakim Family _______________________________

______________________________ _____________________________________

______________________________ _____________________________________

_______________________________ ____________________________________

_______________________________ ____________________________________

7. General Questions

7.1 If a reunion of the Hakim family is organized will you participate?

Yes__ No__ May Be__

7.2 In which year will you prefer the reunion? 1999____ 2000_____

7.3 In which Month will you prefer the reunion? 1, 2, 3, 4, 5, 6, 7, 8, 9,

10, 11, 12

7.4 Are you prepared to help in organizing the reunion? Yes____ No____ If

yes ,

in which areas:________________________________________________________

____________________________________________________________________

7.5 Do you have any pictures of Hakim family members that passed away?

Uncle/aunt, Father/Mother, Grandfather/Grandmother, Grand Grandfather/ Grand

Grandmother, etc.

Describe whose Pictures do you have ______________________________________

____________________________________________________________________

____________________________________________________________________

7.6 Do you any Hakim family member that you know and that we should

contact? If yes, please give the following information:

First and Last Name ____________________________________________________

Address in full _________________________________________________________

____________________________________________________________________

First and Last Name ____________________________________________________

Address in full _________________________________________________________

First and Last Name ____________________________________________________

Address in full _________________________________________________________

____________________________________________________________________