Kia mohio ahau ki to korero tuku kei raro iho nei, kia taea ai e matou te tuku hononga ki a koe hei utu:
(1) Ingoa / Ingoa Kamupene________________
(2) nama waea________________
(3) Wāhitau________________
(4) Taone___________
(5) State_____________
(6) Whenua________________
(7) Waehere poutāpeta________________
(8) Īmēra________________