---- -----~-

Details of Ex-S ou~--s - - - 2nd Ex-s ouse

Is spouse employed, ii so,
wh,1L 1s his/her· monthly
income"?

Children
(Minor and Maior)
Child No. 1
\1\-Z ,~9~h
Full Name
and Surname
c_,~\ ~C\

Date of Birth

Relation s hip
to d eceased

Gua1·dian's
Full Name
and Surname l\.)I , r ,
M ,.FC.h1':>c.l') ""-\} , '"n' ·:xi " \ . J ' \..,t\ I '::ic/)
SLrc.d: Slr~l~ Sl, ,~l
\--\ c.1 rd' "1 \~\Ct r d, f\0 ~\a rd, 01
4 L,.o u
4b~ 0 46 -n- u

~ Qc cJ)~ ~ nl
I

Relationship ·<\
to Guardian
Level of
C / ~~ I\ ()c::, /
' 0() / <.
'0() /,_ I oo 1.. \
\
I \ C,
Ocpcndcncv \-\nN \cn~ 'r\ei~,)\ (f'\\
l\i~ttN•"' ti'} ~ \~\)\((\\ '\(.ct,1CI rj
School /
\.)\\\"iS~ ~\,9~ \--\, s~
Tertiary
Education
C1 rr.J~ 12 \-\ i':)f\
G,~c \() ~ <-\Ii\. \ \
c.r c,,,lc \ 1
level [Gradel
Full time/
Part time
L.--_,,__
study _ __ - -- --~--
\
Contact ()7 '6 4~'> 06~ 0 .. 7T 7
Phone 0135 4~la
Numbers
E-mail
\\
'), r\.'."\\t
Address i S\ 00\ \ (' ~ I(') °i\C: yt ':)
Marital status
Working
~(~
'½i.3\ ~j:·, ,
~-:.s
~o,, t" lo C.q\.~t
')\:)\ ,.,, "' ~

(Give details)
Earnings per
month