For use in Integrity Processing by a Hubbard Integrity Processing Specialist. See BTB 5 DEC 72 for procedure.
Auditor: ____________________________Preclear: _____________________________
Org: _________________________________Date: _______________________________
1. Have you ever lived or worked under an assumed name?_________
2. Have you given me your right name?_________
3. Are you here for a different purpose than you say?_________
4. Have you ever stolen anything?_________
5. Have you ever forged someone else’s signature?_________
6. Have you ever blackmailed anybody?_________
7. Have you ever done anything for which you could be blackmailed?_________
8. Have you ever smuggled anything?_________
9. Have you ever been in prison?_________
10. Have you ever indulged in drunkenness?_________
11. Have you ever done any reckless driving?_________
12. Have you ever burglarized any place?_________
13. Have you ever embezzled money?_________
14. Have you ever assaulted anyone?_________
15. Have you ever told lies in court?_________
16. Have you had anything to do with pornography?_________
17. Have you ever committed arson?_________
18. Have you ever been a drug addict?_________
19. Have you ever peddled dope?_________
20. Have you had any dealings with stolen goods?_________
21. Do you have a police record?_________
22. Have you ever raped anyone?_________
23. Have you ever been involved in an abortion?_________
24. Have you ever committed adultery?_________
25. Have you ever practiced homosexuality?_________
26. Have you ever had intercourse with a member of your family?_________
27. Have you ever been sexually unfaithful?_________
28. Have you ever made a practice of sexual perversion?_________
29. Have you ever slept with someone you shouldn’t have?_________
30. Have you ever committed culpable homicide?_________
31. Have you ever bombed anything?_________
32. Have you ever murdered anyone?_________
33. Have you ever kidnapped anyone?_________
34. Have you ever traded illegally?_________
35. Have you ever betrayed anyone for money?_________
36. Have you ever threatened anyone with a firearm?_________
37. Have you been in illegal possession of firearms?_________
38. Have you ever been paid for giving evidence?_________
39. Have you ever destroyed something belonging to someone else?_________
40. Have you ever been a spy for an organization?_________
41. Have you ever been an informer?_________
42. Have you ever been a member of an illegal organization?_________
43. Have you ever falsely reported?_________
44. Have you ever had intercourse while under the influence of drugs?_________
45. Have you ever had intercourse while under the influence of alcohol?_________
46. Have you ever used drugs or alcohol to procure sex?_________
47. Have you ever ill-treated children?_________
48. Have you ever taken money for giving someone sexual intercourse?_________
49. Have you ever had any connection with a brothel?_________
50. Have you ever gotten another into trouble for something you did?_________
51. Have you ever been a spy for the police?_________
52. Have you done something you are afraid the police may find out?_________
53. Have you ever falsified the books in any firm you worked for?_________
54. Have you ever disclosed confidential data?_________
55. Have you ever done anything your mother would be ashamed to find out about?_________
56. Have you ever purposely injured yourself?_________
57. Have you committed any overts against yourself?_________
58. Have you committed any overts against your family?_________
59. Have you ever harmed an organization?_________
60. Have you ever betrayed the trust of a group?_________
61. Have you ever killed or maimed animals for pleasure?_________
62. Have you ever mistreated animals?_________
63. Have you ever administered electric shock?_________
64. Have you ever tried to make someone insane?_________
65. Have you ever maliciously destroyed trees or plants?_________
66. Have you ever destroyed or damaged another’s property?_________
67. Have you ever taken part in sabotage?_________
68. Have you ever harmed a religion?_________
69. Have you ever persecuted another for their religious beliefs?_________
70. Have you ever violated the tenets of a religion to which you belonged?_________
71. Have you ever injured Dianetics or Scientology?_________
72. Have you ever committed any overts on a Scientology Organization?_________
73. Have you ever belonged to a group opposed to Scientology?_________
74. Have you ever stolen anything from a Scientology Organization?_________
75. Do you have any overts on LRH?_________
76. Have you done anything you wouldn’t want LRH to know about?_________
77. Do you have any overts on Mary Sue Hubbard?_________
78. Is there something Mary Sue Hubbard shouldn’t know about you?_________
79. Have you ever injured any Scientologists?_________
80. Have you ever betrayed Scientology?_________
81. Do you know of any secret plans against Scientology?_________
82. Have you ever taken money to injure Scientology?_________
83. Have you ever used Dianetics or Scientology to force sex on somebody?_________
84. Do you know of any plans to injure a Scientology Organization?_________
85. Have you done something that should never be found out?_________
86. Is there something you have avoided telling me?_________
[Questions 57 and 58 on the previous page have been corrected per HCO PL 7 April 1961RA, Revised 30 May 1975, Johannesburg Confessional List-Revised, a complete copy of which is in Volume VIII, page 419.]