NOTE : If you dont know the answers, please copy from another applikason phorom and submit.
For further instructions, see bottom of applikason. Please do not shoot the person at the applikason kounter.
He will give you the lisence immediately.
Last name: (Yadav/Sinha/Pandey/Mishra/do not know)
First name:
(_) ramprasad
(_) Lakhan
(_) Sivaprasad
(_) Jamnaprasad
(_) Dont know
(Check appropriate box)
Age:
(_) Less than zero
(_) Zero
(_) Greater than zero
(_) Don't know
Sex: ____ M _____ F _____ not sure _____ not applicable
Chappal Size: ____ Left ____ Right
Occupation:
(_) Farmer
(_) Mechanic
(_) Pehelwaan ( Punjabi for "wrestler")
(_) House wife
(_) Un-employed
Spouse's Name: __________________________
Relationship with spouse :
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet
Number of children living in household: ___
Number that are yours: ___
Mother's Name: _______________________
Father's Name: _______________________
(If not sure, leave blank)
Education: 1 2 3 4 (Circle highest grade completed)
Do you (_)own or (_)rent your home? (Check appropriate box)
___ Total number of vehicles you own
___ Number of vehicles that still crank
___ Number of vehicles in front yard
___ Number of vehicles in back yard
___ Number of vehicles on cement blocks
Firearms you own and where you keep them:
____ truck
____ bedroom
____ bathroom
____ kitchen
____ shed
Model and year of your pickup: _____________ 194_
Do you have a gun rack? (_)Yes (_) No; If no, please explain:
Newspapers/magazines you subscribe to:
(_) Champak
(_) Indrajal
(_) Star and style
(_) The great Punjab Dairy
(_) Blank sheets
___ Number of times you've SHOT a UFO
___ Number of times you've SHOT another person exactly like you
___ Number of times you've SHOT yourself.(SHOOTING YOURSELF IN MIRROR IS POOR SHOOTING)
Do you bath?
(_) Yes
(_) No
(_) Not applicable
If yes, how often do you bath?
(_) Weekly
(_) Monthly
(_) Yearly
Color of teeth:
(_) Yellow
(_) Brownish-Yellow
(_) Brown
(_) Black
(_) Others - Give exact color (call nearest Asian Paints dealer if U dont know the color of your teeth) :______________
(_) Not applicable
How far is your home from a paver road?
(_)1 mile (_)2 miles (_)don't know
____________________
Your thumb impresson
(If you are copying from another applikason pharom, please do not copy thumb impression also. Please provide your own thumb impression.
PLEASE DO NOT USE FINGERS ON YOUR LEGS.
Use thumb on your left hand only. If you dont have left hand, use your thumb on right hand. If you do not have right hand, use thumb on left hand.
NOTE : IF YOU DONT HAVE BOTH HANDS, YOU CANNOT DRIVE.)
For instructions to fill this applikason pharom, see beginning of applikason phorom.
