Protected: Malu

Age: 22 years old
Blood group: B
Height: 170
Weight (lbs): 48 kg
Hair Color: Light brown
Eye Color: Hazel
Highest Level of education: Bachelor Degree
College Major: Tourism
What was your college GPA? A+
Ethnicity: Indian
Business Administration Technological College Do you have any artistic abilities? Please List: Singing and Trombone
Do you have any athletic abilities? Please list: Swimming
Occupation? Model/student

Do you wear or have you worn eyeglasses? If yes, at what age did you start wearing them? No

Have you worn braces? No

Why do you want to become a donor? To help women become mothers.

Do you feel prepared to commit to this process? Yes

Are you open to being matched with all types of families regardless of sexual preference, marital status, ethnicity or sex of the egg recipient? If no, please explain.Yes

If they request it, are you willing to meet your intended parents? Yes

Are you open to meeting the child in the future if that is requested? Yes

Are you open to exchanging future contact information with your intended Parents(s)? No

Do you have any siblings? If so, tell us about each of them: No

Do you have any children? If so, tell us about each of them: No

Personal Health History

Any past or current medical problems (including surgeries, accidents, birth defects, depression, etc.)? If yes, please list: No

Do you drink alcohol? If yes, how many drinks per week? No

Have you ever been pregnant? If yes, how many times and what was the out-come? I have never been pregnant.

Have you ever been a donor before? If yes, did a pregnancy occur? Yes

Are you currently taking any medication (for physical or mental health)? If yes, what medications are you on and why? No

Are you taking any recreational drugs? If yes, what are you taking? No

Do you smoke? No

Are your menstrual cycles regular? If no, please explain: Yes

Family Medical History

Note: Medical history will be verified. Anything purposefully omitted may result in being dropped from the program. If any of the following has occurred in your family, please list which family member and explain:

Family Genetic History

Biological Family Member Sex Age Height Eye Color Hair Color Education Level Deceased Occupation
Father M 80 190 Blue Light brown Bachelor’s degree retired
Mother F 55 160 Light brown Light brown collage House wife
Paternal Grandmother F blue Light brown Bachelor’s degree ⁄
Paternal Grandfather M blue Light brown Bachelor’s degree ⁄
Maternal Grandmother F 72 160 Light brown Light brown collage Business owner
Maternal Grandfather M 75 185 Light brown Light brown collage Business owner

Disease/Medical Condition Check one To Whom Passed away? Age of onset/Medication Age at the time of passing

Cancer No No

Mental Retardation No No

Autism / Asperger’s No No

Physical Malformation No No

Paralysis or crippling disorders No No

Alcohol or Drug Addiction No No

Cystic Fibrosis No No
Sickle Cell Anemia No No

Lupus No No

Miscarriages, still births, neonatal

deaths□ No No

High blood pressure, heart attacks

or strokes□ No No

Memory loss or dementia No No

Osteoporosis No No

Arthritis No No

Allergies No No

Blood diseases No No

Diabetes (Specifically Type 1 or Type 2)□ No No

Thyroid issues No No

Learning disabilities No No

Seizure or epilepsy No No

Disease/Medical Condition Check one Passed away? Age of onset/Medication Age at the time of passing

Depression No No

Panic attacks No No

Schizophrenia No No

Bipolar Disorder No No


Age-related issues No No

Kidney problems / diseases No No

Reproductive problems: i.e. endometriosis, hysterectomies, lateterm miscarriages, etc. No No

Vision/Sight/Eye Problems No No