NOTE: If you dont knows, please copy from another applikason phorom.

For phurthar instructions, see bottom applikason.
Please do not soot the person at the applikason kounter. He will give you the licen. 

Last name:
(_) Yadav
(_) Sinha
(_) Pandey
(_) Misra
(_) Dot no
(Check karet box)

First name:
(_) Ramprasad
(_) Lakhan
(_) Sivprasad
(_) Jamnaprasad
(_) Dot no
(Check karet box) 

Age:
(_) Less than phipty
(_) Greater than phipty
(_) Dot no
(Check karet box) 
 

Sex:
____ M _____ P(F) _____ not sure _____not applicable 

Chappal Size:
____ Lepht ____ Right

Occupason:
(_) Politison
(_) Doodhwala
(_) Pehelwaan
(_) House wife
(_) Un-employed
(Check karet box) 

Number of children libing in the household: ___

Number that are yours: ___

Mother name: _______________________
Phather Name: ____________________ (If not no, leave blank)
Ejjucason: 1 2 3 4 (Circle highest grade completed) 

Dental rekard: 
(_) Ellow 
(_) Berownish-ellow 
(_) Berown 
(_) Belack 
(_) Other - Give egjhakt color
Check karet box) 

Your thumb imparesson

(If you are copying from another applikason pharom, please do not copy thumb impresson also. Please provide your own thumb impresson.)

PELEASE DO NOT USE PHINGERS OF YOUR LEGS

Use thumb on your lepht hand only. If you don't have lepht hand, use your thumb on right hand. If you do not have right hand, use thumb on lepht hand.


NOTE: IF YOU DON'T HAVE BOTH HANDS, YOU CANNOT DRIVE.
WE ARE VARY ISTRICT ABOUT THIS