Physical Attributes

Recommended number of straws to beused per procedure:

IUIIVFICSI

Not recommendedNot recommended

1 straw

p|1 VPW099

AEVITAS FERTILITY CLINIC

Donor ProfileThis donor is recommended for ICSI only. The following information has been provided voluntarily and is disclosed to futureparents as an aid in their selection.

General Information And Characteristics

Ethnic:  South AfricanRace: CaucasianHeight (m): 1.82Weight (kg): 98Shoe Size: 10Blood Group: AB PosPredominent Hand:

Personal Details

What are you studying? Studied law for 2 years (stopped due to financial reasons)Religion: ChristianMarital Status: SingleChildren: 0Are you adopted? No

VPW099

I'm a positive, happy­go­lucky and energetic personwith a vibrant personality

Personality

Describe yourself and personalityI am a very positive, happy­go­lucky and energetic personwith a vibrant personality. I know when to have fun but alsowhen to be serious.

Describe any special skills, talents and abilities youhave:I learn things very quickly and easily. I am very good atcooking and the culinary arts.

What values are most important to you?Honesty, loyalty, reliability, punctuality, positivity, trust.

Education

School Matric Subjects:Afrikaans, English, Biology, Accounting, Home Economics,Geography, Speech and Drama

Favourite School Subjects:Drama, Geography and Home Economics

Matric Aggregate Symbol:A

School Cultural Activities (Music/Art etc):Drama

School Sports:Tennis

School Awards/Prizes:Numerous Academic Awards/Certificates throughout school

Tertiary Education:Studied Law for 2 years (stopped due to finances)

Other Qualifications:

Future Educational Plans and Career Goals:Culinary Chef Course/ Marketing degree

AEVITAS FERTILITY CLINIC

p|2 VPW099

Facial Freckles: None , Few , NumerousDimples: None , Slight , Medium , DeepMoles: None , None , Several , Numerous

Nose

Nose Size: Small , Medium , LargeNose Width: Narrow , Average , WideNose Length: Short , Average , LongNose Bridge: Concave , Straight , Convex

Hair & Ears

Hair colour at birth: Black ,  Brown ,  Blonde ,  RedHair colour as an adult: Black ,  Brown ,  Blonde ,  RedHair texture: Fine ,  Medium ,  CourseHair fullness: Thin ,  Medium ,  Thick ,  BaldingHair trait: Straight ,  Wavy ,  Curly ,  Very CurlyEar size: Small ,  Medium ,  Large

Mouth

Mouth Size: Small ,  Average ,  LargeLips: Thin ,  Average ,  Full

Dental

Dental Condition: Poor ,  Fair ,  ExcellentBraces: Yes ,  NoPalette Shape: Narrow ,  Average ,  Wide ,  Buck

Eyes

Eye Colour: Brown ,  Green ,  Blue ,  Hazel ,  Eye Set: Narrow ,  Average ,  WideEye Size: Small ,  Average ,  LargeEye Sight: Short ,  Normal ,  FarEyebrow Arc: Flat ,  Medium ,  HighEyebrow Thickness: Thin ,  Medium ,  Thick

AEVITAS FERTILITY CLINIC

p|3 VPW099

I learn things very quicklyand easily.

Family Medical History

Are there any known genetic diseases or conditionsthat run in your family?No

Have you or anyone in your family ever been tested asa carrier for any genetic disease? (Give details ifnecessary):No

Are there any twins or triplets in your family? (Givedetails, if ‘yes’)No

Is there anything else you would like to disclose aboutyou and your family in regard to raising a childconceived with your sperm?No

Leisure Activities

Hobbies and/or interests since leaving school:Cooking, reading, socializing

Sports or outdoor activities:Playing Squash

Clubs or organisations:

Do you play any musical instruments?None

Medical History

Have you ever smoked for a prolonged period before?:Yes

Do you currently smoke?:No

Do you drink alcohol and if so, how often?Yes, at weekends

Have you ever used any illicit drugs? Give details please:No

Please list any significant illnesses/operations you have had:Sinusitis

Please list any prescription drugs, complementary medication orsupplements you are currently taking and any medical conditionsfor which you are currently being seen/treated:Sinus medication

Have you ever had psychological or care?:No

Have you ever had psychiatric care?:No

How would you describe your health presently?:Very good

Physical Attributes

Recommended number of straws to beused per procedure:

IUIIVFICSI

Not recommendedNot recommended

1 straw

p|1 VPW099

AEVITAS FERTILITY CLINIC

Donor ProfileThis donor is recommended for ICSI only. The following information has been provided voluntarily and is disclosed to futureparents as an aid in their selection.

General Information And Characteristics

Ethnic:  South AfricanRace: CaucasianHeight (m): 1.82Weight (kg): 98Shoe Size: 10Blood Group: AB PosPredominent Hand:

Personal Details

What are you studying? Studied law for 2 years (stopped due to financial reasons)Religion: ChristianMarital Status: SingleChildren: 0Are you adopted? No

VPW099

I'm a positive, happy­go­lucky and energetic personwith a vibrant personality

Personality

Describe yourself and personalityI am a very positive, happy­go­lucky and energetic personwith a vibrant personality. I know when to have fun but alsowhen to be serious.

Describe any special skills, talents and abilities youhave:I learn things very quickly and easily. I am very good atcooking and the culinary arts.

What values are most important to you?Honesty, loyalty, reliability, punctuality, positivity, trust.

Education

School Matric Subjects:Afrikaans, English, Biology, Accounting, Home Economics,Geography, Speech and Drama

Favourite School Subjects:Drama, Geography and Home Economics

Matric Aggregate Symbol:A

School Cultural Activities (Music/Art etc):Drama

School Sports:Tennis

School Awards/Prizes:Numerous Academic Awards/Certificates throughout school

Tertiary Education:Studied Law for 2 years (stopped due to finances)

Other Qualifications:

Future Educational Plans and Career Goals:Culinary Chef Course/ Marketing degree

AEVITAS FERTILITY CLINIC

p|2 VPW099

Facial Freckles: None , Few , NumerousDimples: None , Slight , Medium , DeepMoles: None , None , Several , Numerous

Nose

Nose Size: Small , Medium , LargeNose Width: Narrow , Average , WideNose Length: Short , Average , LongNose Bridge: Concave , Straight , Convex

Hair & Ears

Hair colour at birth: Black ,  Brown ,  Blonde ,  RedHair colour as an adult: Black ,  Brown ,  Blonde ,  RedHair texture: Fine ,  Medium ,  CourseHair fullness: Thin ,  Medium ,  Thick ,  BaldingHair trait: Straight ,  Wavy ,  Curly ,  Very CurlyEar size: Small ,  Medium ,  Large

Mouth

Mouth Size: Small ,  Average ,  LargeLips: Thin ,  Average ,  Full

Dental

Dental Condition: Poor ,  Fair ,  ExcellentBraces: Yes ,  NoPalette Shape: Narrow ,  Average ,  Wide ,  Buck

Eyes

Eye Colour: Brown ,  Green ,  Blue ,  Hazel ,  Eye Set: Narrow ,  Average ,  WideEye Size: Small ,  Average ,  LargeEye Sight: Short ,  Normal ,  FarEyebrow Arc: Flat ,  Medium ,  HighEyebrow Thickness: Thin ,  Medium ,  Thick

AEVITAS FERTILITY CLINIC

p|3 VPW099

I learn things very quicklyand easily.

Family Medical History

Are there any known genetic diseases or conditionsthat run in your family?No

Have you or anyone in your family ever been tested asa carrier for any genetic disease? (Give details ifnecessary):No

Are there any twins or triplets in your family? (Givedetails, if ‘yes’)No

Is there anything else you would like to disclose aboutyou and your family in regard to raising a childconceived with your sperm?No

Leisure Activities

Hobbies and/or interests since leaving school:Cooking, reading, socializing

Sports or outdoor activities:Playing Squash

Clubs or organisations:

Do you play any musical instruments?None

Medical History

Have you ever smoked for a prolonged period before?:Yes

Do you currently smoke?:No

Do you drink alcohol and if so, how often?Yes, at weekends

Have you ever used any illicit drugs? Give details please:No

Please list any significant illnesses/operations you have had:Sinusitis

Please list any prescription drugs, complementary medication orsupplements you are currently taking and any medical conditionsfor which you are currently being seen/treated:Sinus medication

Have you ever had psychological or care?:No

Have you ever had psychiatric care?:No

How would you describe your health presently?:Very good

Physical Attributes

Recommended number of straws to beused per procedure:

IUIIVFICSI

Not recommendedNot recommended

1 straw

p|1 VPW099

AEVITAS FERTILITY CLINIC

Donor ProfileThis donor is recommended for ICSI only. The following information has been provided voluntarily and is disclosed to futureparents as an aid in their selection.

General Information And Characteristics

Ethnic:  South AfricanRace: CaucasianHeight (m): 1.82Weight (kg): 98Shoe Size: 10Blood Group: AB PosPredominent Hand:

Personal Details

What are you studying? Studied law for 2 years (stopped due to financial reasons)Religion: ChristianMarital Status: SingleChildren: 0Are you adopted? No

VPW099

I'm a positive, happy­go­lucky and energetic personwith a vibrant personality

Personality

Describe yourself and personalityI am a very positive, happy­go­lucky and energetic personwith a vibrant personality. I know when to have fun but alsowhen to be serious.

Describe any special skills, talents and abilities youhave:I learn things very quickly and easily. I am very good atcooking and the culinary arts.

What values are most important to you?Honesty, loyalty, reliability, punctuality, positivity, trust.

Education

School Matric Subjects:Afrikaans, English, Biology, Accounting, Home Economics,Geography, Speech and Drama

Favourite School Subjects:Drama, Geography and Home Economics

Matric Aggregate Symbol:A

School Cultural Activities (Music/Art etc):Drama

School Sports:Tennis

School Awards/Prizes:Numerous Academic Awards/Certificates throughout school

Tertiary Education:Studied Law for 2 years (stopped due to finances)

Other Qualifications:

Future Educational Plans and Career Goals:Culinary Chef Course/ Marketing degree

AEVITAS FERTILITY CLINIC

p|2 VPW099

Facial Freckles: None , Few , NumerousDimples: None , Slight , Medium , DeepMoles: None , None , Several , Numerous

Nose

Nose Size: Small , Medium , LargeNose Width: Narrow , Average , WideNose Length: Short , Average , LongNose Bridge: Concave , Straight , Convex

Hair & Ears

Hair colour at birth: Black ,  Brown ,  Blonde ,  RedHair colour as an adult: Black ,  Brown ,  Blonde ,  RedHair texture: Fine ,  Medium ,  CourseHair fullness: Thin ,  Medium ,  Thick ,  BaldingHair trait: Straight ,  Wavy ,  Curly ,  Very CurlyEar size: Small ,  Medium ,  Large

Mouth

Mouth Size: Small ,  Average ,  LargeLips: Thin ,  Average ,  Full

Dental

Dental Condition: Poor ,  Fair ,  ExcellentBraces: Yes ,  NoPalette Shape: Narrow ,  Average ,  Wide ,  Buck

Eyes

Eye Colour: Brown ,  Green ,  Blue ,  Hazel ,  Eye Set: Narrow ,  Average ,  WideEye Size: Small ,  Average ,  LargeEye Sight: Short ,  Normal ,  FarEyebrow Arc: Flat ,  Medium ,  HighEyebrow Thickness: Thin ,  Medium ,  Thick

AEVITAS FERTILITY CLINIC

p|3 VPW099

I learn things very quicklyand easily.

Family Medical History

Are there any known genetic diseases or conditionsthat run in your family?No

Have you or anyone in your family ever been tested asa carrier for any genetic disease? (Give details ifnecessary):No

Are there any twins or triplets in your family? (Givedetails, if ‘yes’)No

Is there anything else you would like to disclose aboutyou and your family in regard to raising a childconceived with your sperm?No

Leisure Activities

Hobbies and/or interests since leaving school:Cooking, reading, socializing

Sports or outdoor activities:Playing Squash

Clubs or organisations:

Do you play any musical instruments?None

Medical History

Have you ever smoked for a prolonged period before?:Yes

Do you currently smoke?:No

Do you drink alcohol and if so, how often?Yes, at weekends

Have you ever used any illicit drugs? Give details please:No

Please list any significant illnesses/operations you have had:Sinusitis

Please list any prescription drugs, complementary medication orsupplements you are currently taking and any medical conditionsfor which you are currently being seen/treated:Sinus medication

Have you ever had psychological or care?:No

Have you ever had psychiatric care?:No

How would you describe your health presently?:Very good

AEVITAS FERTILITY CLINIC

p|4 VPW099

Mother Father Sibling 1 Sibling 2

Race White White

EthnicAncestry

Height (m) 1.77 1.72

Weight (kg)

Eye Colour Brown Brown

Natural HairColour

Red Black

Natural HairType

Straight Curly

PhysicalBuild

Average Average

SpecialSkills,Talents

Singing

GeneralHealth

Good Deceased

Personality Outgoing Outgoing

Occupation Administrator Fitter

HighestQualification

Certificate Matric

AEVITAS FERTILITY CLINIC

p|5 VPW099

Family ProfileHave you or any of your immediate family (parents, grandparents or siblings) ever had any of the following? (If yes, list thefamily member with the disorder):

Condition No Yes Member Details

Alcoholism X

Allergies X

Alzheimer’s disease X

Anaemia X

Arthritis X

Asthma or other lung disorders X Paternal Grandfather

Cancer (type and age of onset) X Maternal Grandfather

Cardiovascular disease X

Cerebralpalsy X

Cystic Fibrosis X

Deafness X

Depression X

Diabetes X

Disorder of eyes or eyesight X

Drug abuse/ addiction X

Emphysema X

Endometriosis X

Epilepsy X

Haemophilia (bleeding disorder) X

High Blood Pressure X Maternal Grandmother

High Cholesetrol X

Hyperactivity X

Inherited Metabolic Disorders X

Kidney Disease X

Learning Disability X

Leukaemia X

Liver Disease X

Migraines X

Multiple Sclerosis X

Muscular Dystrophy X

Osteoporosis X

Ovarian Cysts X

Psychological Disorders X

Psychiatric Disorders X

Sickle Cell Anaemia X

Skin Disorders X

Tay­Sach's Disease X

Thalassemia X

Thyroid Disease X

Tuberculosis X

Ulcers X

AEVITAS FERTILITY CLINIC

p|6 VPW099

Questions AnswersWhich celebrity(ies) do you think you look most similar too?Daniel Sunjata (only lighter)

What are some of the highlights of your life?Buying my AUDI A4 at age 28. Being healthy until now (and hopefully for awhile to come)

If you could meet anyone in the world (living or deceased), whowould it be and why?James Dean ­ would like to know what his views would be on what the worldis like today.

If you had a free afternoon, what would you spend it doing?Walking my Boston Terrier on the beach.

If you could have one superpower, what would you be able to do?Read minds (people and animals) and the ability to heal.

If you could do any activity, without having to worry about travel ormoney, what activity would it be?Visit Italy / Mediterranean

Which kind of charity would you choose to donate to if you had themeans?Any charity related to farm attacks

If you could pick any course at university, what would it most likelybe?Hospitality / Marketing

If you were reincarnated as an animal, which one would it be?A jaguar

If you were on a survival course, what would be your “I can’t livewithout it” item?My spectacles

If you were about to walk the plank, what would your last meal be?Seafood

Reasons for Donating

Why do you want to become a donor?If I can play a part in realizing a couples dream they are struggling with,why not?

What qualities do you think are important for parents to have?They have to be stable, in a good place mentally to take the big step ofraising another being into the world.

If you could send a message to your prospective recipient, what would it be?

Make the most of every moment you will have with your child. They will cherish itforever.

AEVITAS FERTILITY CLINIC

p|4 VPW099

Mother Father Sibling 1 Sibling 2

Race White White

EthnicAncestry

Height (m) 1.77 1.72

Weight (kg)

Eye Colour Brown Brown

Natural HairColour

Red Black

Natural HairType

Straight Curly

PhysicalBuild

Average Average

SpecialSkills,Talents

Singing

GeneralHealth

Good Deceased

Personality Outgoing Outgoing

Occupation Administrator Fitter

HighestQualification

Certificate Matric

AEVITAS FERTILITY CLINIC

p|5 VPW099

Family ProfileHave you or any of your immediate family (parents, grandparents or siblings) ever had any of the following? (If yes, list thefamily member with the disorder):

Condition No Yes Member Details

Alcoholism X

Allergies X

Alzheimer’s disease X

Anaemia X

Arthritis X

Asthma or other lung disorders X Paternal Grandfather

Cancer (type and age of onset) X Maternal Grandfather

Cardiovascular disease X

Cerebralpalsy X

Cystic Fibrosis X

Deafness X

Depression X

Diabetes X

Disorder of eyes or eyesight X

Drug abuse/ addiction X

Emphysema X

Endometriosis X

Epilepsy X

Haemophilia (bleeding disorder) X

High Blood Pressure X Maternal Grandmother

High Cholesetrol X

Hyperactivity X

Inherited Metabolic Disorders X

Kidney Disease X

Learning Disability X

Leukaemia X

Liver Disease X

Migraines X

Multiple Sclerosis X

Muscular Dystrophy X

Osteoporosis X

Ovarian Cysts X

Psychological Disorders X

Psychiatric Disorders X

Sickle Cell Anaemia X

Skin Disorders X

Tay­Sach's Disease X

Thalassemia X

Thyroid Disease X

Tuberculosis X

Ulcers X

AEVITAS FERTILITY CLINIC

p|6 VPW099

Questions AnswersWhich celebrity(ies) do you think you look most similar too?Daniel Sunjata (only lighter)

What are some of the highlights of your life?Buying my AUDI A4 at age 28. Being healthy until now (and hopefully for awhile to come)

If you could meet anyone in the world (living or deceased), whowould it be and why?James Dean ­ would like to know what his views would be on what the worldis like today.

If you had a free afternoon, what would you spend it doing?Walking my Boston Terrier on the beach.

If you could have one superpower, what would you be able to do?Read minds (people and animals) and the ability to heal.

If you could do any activity, without having to worry about travel ormoney, what activity would it be?Visit Italy / Mediterranean

Which kind of charity would you choose to donate to if you had themeans?Any charity related to farm attacks

If you could pick any course at university, what would it most likelybe?Hospitality / Marketing

If you were reincarnated as an animal, which one would it be?A jaguar

If you were on a survival course, what would be your “I can’t livewithout it” item?My spectacles

If you were about to walk the plank, what would your last meal be?Seafood

Reasons for Donating

Why do you want to become a donor?If I can play a part in realizing a couples dream they are struggling with,why not?

What qualities do you think are important for parents to have?They have to be stable, in a good place mentally to take the big step ofraising another being into the world.

If you could send a message to your prospective recipient, what would it be?

Make the most of every moment you will have with your child. They will cherish itforever.

AEVITAS FERTILITY CLINIC

p|4 VPW099

Mother Father Sibling 1 Sibling 2

Race White White

EthnicAncestry

Height (m) 1.77 1.72

Weight (kg)

Eye Colour Brown Brown

Natural HairColour

Red Black

Natural HairType

Straight Curly

PhysicalBuild

Average Average

SpecialSkills,Talents

Singing

GeneralHealth

Good Deceased

Personality Outgoing Outgoing

Occupation Administrator Fitter

HighestQualification

Certificate Matric

AEVITAS FERTILITY CLINIC

p|5 VPW099

Family ProfileHave you or any of your immediate family (parents, grandparents or siblings) ever had any of the following? (If yes, list thefamily member with the disorder):

Condition No Yes Member Details

Alcoholism X

Allergies X

Alzheimer’s disease X

Anaemia X

Arthritis X

Asthma or other lung disorders X Paternal Grandfather

Cancer (type and age of onset) X Maternal Grandfather

Cardiovascular disease X

Cerebralpalsy X

Cystic Fibrosis X

Deafness X

Depression X

Diabetes X

Disorder of eyes or eyesight X

Drug abuse/ addiction X

Emphysema X

Endometriosis X

Epilepsy X

Haemophilia (bleeding disorder) X

High Blood Pressure X Maternal Grandmother

High Cholesetrol X

Hyperactivity X

Inherited Metabolic Disorders X

Kidney Disease X

Learning Disability X

Leukaemia X

Liver Disease X

Migraines X

Multiple Sclerosis X

Muscular Dystrophy X

Osteoporosis X

Ovarian Cysts X

Psychological Disorders X

Psychiatric Disorders X

Sickle Cell Anaemia X

Skin Disorders X

Tay­Sach's Disease X

Thalassemia X

Thyroid Disease X

Tuberculosis X

Ulcers X

AEVITAS FERTILITY CLINIC

p|6 VPW099

Questions AnswersWhich celebrity(ies) do you think you look most similar too?Daniel Sunjata (only lighter)

What are some of the highlights of your life?Buying my AUDI A4 at age 28. Being healthy until now (and hopefully for awhile to come)

If you could meet anyone in the world (living or deceased), whowould it be and why?James Dean ­ would like to know what his views would be on what the worldis like today.

If you had a free afternoon, what would you spend it doing?Walking my Boston Terrier on the beach.

If you could have one superpower, what would you be able to do?Read minds (people and animals) and the ability to heal.

If you could do any activity, without having to worry about travel ormoney, what activity would it be?Visit Italy / Mediterranean

Which kind of charity would you choose to donate to if you had themeans?Any charity related to farm attacks

If you could pick any course at university, what would it most likelybe?Hospitality / Marketing

If you were reincarnated as an animal, which one would it be?A jaguar

If you were on a survival course, what would be your “I can’t livewithout it” item?My spectacles

If you were about to walk the plank, what would your last meal be?Seafood

Reasons for Donating

Why do you want to become a donor?If I can play a part in realizing a couples dream they are struggling with,why not?

What qualities do you think are important for parents to have?They have to be stable, in a good place mentally to take the big step ofraising another being into the world.

If you could send a message to your prospective recipient, what would it be?

Make the most of every moment you will have with your child. They will cherish itforever.