ish-State of bihaar reghstry porom

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STATE of BIHAR DRIVING LICENSE APPLIKASON POROM

NOTE: If you dont know the answers, please copy from another
applikason
phorom and submit. For further instructions, see bottom
applikason.Please
do not shoot the person at the applikason kounter. He will give
you the
licen immediately.

Last name:

(_) Yadav

(_) Sinha

(_) Pandey

(_) Misra

(_) do not know

(Check appropriate box)


First name:

(_) Ramprasad

(_) Lakhan

(_) Sivprasad

(_) Jamnaprasad

(_) Dont know

(Check appropriate box)


Age:

(_) Less than Fifty

(_) Greater than fifty

(_) Don't know

(Check appropriate box)


Sex: ____ M _____ F _____ not sure _____not applicable


Chappal Size: ____ Left ____ Right


Occupation:

(_) Politician

(_) Doodhwala

(_) Pehelwaan

(_) House wife

(_) Un-employed

(Check appropriate box)


Number of children living in household: ___

Number that are yours: ___


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

(Check appropriate box)


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)


How far is your home from a paved road?

(_)1 mile (_)2 miles (_)don't know (Check appropriate box)


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 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.


WE ARE VARY ISTRICT ABOUT THIS

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