Baptism

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Baptism

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Afrikaanse Sertifikaat

English Certificate

Surname / Van:

Full names / Volle voorname:

Date of birth / Geboortedatum:

Physical address / Huisadres

Telephone number / Telefoon nommer:

Cellphone number / Selfoon nommer:

E-mail address / E-pos adres:

Date of repentance / Datum van bekering:

Have you been baptized in the Holy Spirit? / Is u reeds gedoop in die Heilige Gees?

No / Nee

Yes / Ja

If yes, please state when / Indien ja, verskaf asb. die datum:

I hereby declare that the information given above is true to the best of my knowledge and belief. / Ek verklaar hiermee dat die inligting hierbo gegee, na die beste van my wete en oortuiging waar is.

YES

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Rouxville, Kuils River,
South Africa, 7580

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021 906 1986

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