Please print this form, fill in the details, and post to us with a preliminary search fee of £25 Sterling
Ulster Historical Foundation,
Cotton Court, 30–42 Waring Street, Belfast, BT1 2ED, Northern Ireland.
Date: ____________________________________
Applicant's Name: _____________________________________________________________________
Address: _____________________________________________________________________________
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In the following questionnaire please give as many details as possible. Please add any other information
which you think may be relevant.
Name of my ancestor: _________________________________________________________________
Date of Birth: _________________________________________________________________________
Place of Birth: ________________________________________________________________________
Father's Name: _______________________________________________________________________
Father's Date of Birth __________________________________________________________________
Mother's Name: ______________________________________________________________________
Mother's Date of Birth: _________________________________________________________________
Their Place of Birth: ___________________________________________________________________
Their religious denomination: ___________________________________________________________
Date/Place of their marriage: ___________________________________________________________
Siblings of Ancestor named above: _______________________________________________________
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When did your ancestor emigrate?: _______________________________________________________
Other relevant information: ______________________________________________________________