Name of Petitioner: ____________________________________

Address: _____________________________________________
Age: __________
Birthday/Birth date: __________________________
Highest Educational Attainment: __________________________
School attended/Year: ___________________________________
Present Employment: ___________________________________
Religion: _______________________
Date of Marriage: _____________________________
Place of Marriage: _____________________________
Number of child/children: ______
Name Age Birth date Education

Family Background
Father: ______________________________________
Age: ______________________________________
Occupation: __________________________________
Negative attitudes: _________________________________________________
_________________________________________________________________
Positive Attitudes: __________________________________________________
__________________________________________________________________
Mother: _____________________________________
Age: ___________
Occupation: _________________________
Negative Attitudes: _________________________________________________
__________________________________________________________________
Positive Attitudes: __________________________________________________
__________________________________________________________________
Siblings (Brothers/ sisters)
Name Age Status Occupation Educational Attainment

Attitudes of each:
Name of Respondent: ____________________________________
Address: _____________________________________________
Age: __________
Birthday/Birth date: __________________________
Highest Educational Attainment: __________________________
School attended/Year: ___________________________________
Present Employment: ___________________________________
Religion: _______________________
Date of Marriage: _____________________________
Place of Marriage: _____________________________
Number of child/children: ______
Name Age Birth date Education

Family Background
Father: ______________________________________
Age: ______________________________________
Occupation: __________________________________
Negative attitudes: _________________________________________________
_________________________________________________________________
Positive Attitudes: __________________________________________________
__________________________________________________________________
Mother: _____________________________________
Age: ___________
Occupation: _________________________
Negative Attitudes: _________________________________________________
__________________________________________________________________
Positive Attitudes: __________________________________________________
__________________________________________________________________
Siblings (Brothers/ sisters)
Name Age Status Occupation Educational Attainment

Attitudes of each:
 A. Describe your family as a whole

B. Describe yourself as a son/daughter. Describe yourself as a sister/brother.

C. What are your vivid childhood memories?

D. Tell something about your biggest achievement and biggest frustrations.

a. Achievement:
b. How do you reward yourself?
c. Frustrations:
d. How did you cope?

E. Family history of Medical/emotional disorders:

Are there any disorder/diseases common to your family members?

F. Pertinent Personal Medical History

Did you have any illness? Medical consultations? Surgical operations?

Are you taking any drug/medicine/ Enumerate.

EDUCATIONAL HISTORY

: Schools attended : Year : awards/degrees

: : : certification

Pre-school
Elementary
High School
Vocational School
College
Post graduate

________________________________________________________________________
Extracurricular Activities

Describe yourself as a student

EMPLOYMENT HISTORY

Where? When? Position?

Monthly Salary

A.
B.
C.
D.

State the reasons for resignation/termination/changing jobs

A
B.
C.
D.

OTHERS

1. Describe yourself as an employee. How do your superiors/subordinates,

perceive you?

2. How do you see yourself ten years from now?

 3. If you can change our world/ yourself at this point what changes would you
have done? Why/

4. How do you think others appraise or estimate you?

5. What are your interest/skills/talents? What did you do develop them?

SOCIAL, SEXUAL AND MARITAL HISTORY

A. Discuss your circle of friends when you were in your childhood,

adolescent years and adulthood.

1. Where did/do you spend your time together?

2. What were / are your usual activities?

B. What are the sorts of problems and conflicts that are usually encounters?

1. How do you cope with frustrations and problems?

C. Did you have any other intimate relationships before your marriage?
Discuss them.

1. What are the causes for the break-up?

2. How did you recover from the break-up?

D. Describe the circumstances surrounding your initial meeting with your

husband/wife.
1. Describe the courtship period.

2. What positive and negative traits of your husband/wife have you observed
during this period.

E. Describe the circumstances and preparations that led your marriage.

1. Discuss the ceremony, its impact on your family and members/in-laws?

F. Describe the first few months of your marriage.

G. When did you first notice changes in your husbands/wifes behavior?

Expound.

H. What was your worst marital experience? What did you do? How did you
cope?

1. Is there anything good/happy/memorable about marriage?

I. What did you do to save your marriage?

J. Did your spouse initiate moves to reconcile with you?

K. Is there any probability for reconciliation? Why?

L. Compare your traits with husbands/ wifes / traits.

Your Good Traits : Your Bad Traits

 Your Spouses Good Traits : Your Spouses ad Traits

Dont forget to discuss in detail the circumstances which explain your spouses traits. Use
the back pages or additional pages to elaborate the above mentioned personality traits.

M. What is your general estimate of yourself?

1. Describe yourself as a mother/father.

2. Describe yourself as a wife/husband.

N. What do you think will be the benefits of having your marriage annulled?

O. Is your husband/wife attending the court hearing? What is his/her

attitude/reaction?

P. How about your in-laws and children? How are they taking your desire for
annulment?

Q. Do you have a suitor/lover at this point? Are you planning to get married
after the annulment? Mentioned the names and ages of your children
outside the marriage.

R. What lessons have you learned from your marriage?

S. Tell everything you know about your spouses background.

T. Tell everything you know about his educational and work history.

U. Tell everything you know about your spouses past and present love
affairs. Names and ages of his/her children with another man/woman.

V. Describe your spouses as a son/daughter to his/her parents and as a

brother/sister to his/her siblings.

W. Where can I get in touch with your husband/wife? Do you think he / she
will be amenable for an interview?

X. Is there a possibility for an interview with your children regarding their

observations of the marital state and their experience with you as a
parents?

Y. Do you have other in formations to add which you think is important to

your decision to annul your marriage? You may use the back page.

Z. Do you think you need psychological help because of the marital failure?
Do you think your children need counseling as a result of the marital
breakdown? Why

I am certifying that all the information I gave are true.

Signature over printed name

Date
Social / Sexual and Marital History

1. How, when and where did you meet your husband/wife?

2. Did you have any other intimate relationship before he/she met you?
3. Do you know of any intimate relationship he/she has before you?
3.1. What are the causes for break-up?
4. Describe the courtship period?
5. Positive traits of your husband/wife which you observed during courtship and when
you were sweethearts?
6. Negative traits of your husband/wife which you observed during courtship and when
you were sweethearts?
7. Discuss the ceremony (marriage).
8. Reasons for marriage (kindly enumerate)
9. What was your worst marital experience? Please discuss.
9.1 What did you do?
9.2 How did you cope?
10. When did you first notice changes in your husbands/wifes behaviors. Expound.
11. What did you do to save your marriage?
12. Did he/she make any move to save the marriage?
13. Did he/she make move to reconcile?
14. Compare your good traits and bad traits as against your partners good and bad traits?
15. Please discuss:
The circumstances which led to your separation and all the good and bad marital
experiences you have experienced.
16. Do you have a lover at this point in time?

Please write an extensive marital history (this is a must)