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: (_) Politician (_) Doodhwala (_) Pehelwaan (_) House wife (_) Criminal (Police records to be attached and certified by local O. C. of Thana ) (_) Un-employed
Number of children living in household: ___
Mother's Name: _______________________ Father's Name: _______________________ (If not sure, leave blank)
Ejjucason: 1 2 3 4 (Circle highest grade completed)
Do you bathe? (_) Yes (_) No (_) Not applicable If yes, how often do you bathe? (_) Weekly (_) Monthly (_) Yearly
Color of teeth: (_) Yellow (_) Brownish-Yellow (_) Brown (_) Black (_) Others - Give exact color (ask nearest Asian Paints dealer if U don't know the color of your teeth)
How far is your home from a paved road? (_) 10 mile (_) 20 miles (_) not seen road in life (_) don't know
____________________ Your thumb imparesson * 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 OF YOUR LEGS. Use thumb on your left hand only. If you don't 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
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