STATE of BIHAR - DRIVING LICENSE APPLIKASON PHARM
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NOTE: If you don’t 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 lisence immediately.
(Check appropriate box)
1. Last name:
(_) Yadav
(_) Sinha
(_) Pandey
(_) Mishra
(_) Don’t know
2. First name:
(_) Ramprasad
(_) Lakhan
(_) Sivaprasad
(_) Jamnaprasad
(_) Don’t know
3. Age:
(_) Less than zero
(_) Zero
(_) Greater than zero
(_) Don't know
4. Sex:
M _____ F _____ not sure! _____ Not applicable
5. Chappal Size:
Left ____ Right ______
5. Occupation:
(_) Politician
(_) Doodhwala
(_) Pehelwaan
(_) House wife
(_) Un-employed
6. Number of children living in household: ___
7. Number that are yours: ___
8. Mother's Name: _______________________
9. Father's Name: _______________________
(If not sure, leave blank)
10. Ejjucason:
1 2 3 4 (Circle highest grade completed)
11. Do you bathe?
(_) Yes (_) No (_) Not applicable
12. If yes, how often do you bathe?
(_) Weekly
(_) Monthly
(_) Yearly
13. Color of teeth:
(_) Yellow
(_) Brownish-Yellow
(_) Brown
(_) Black
(_) Others - Give exact color (call nearest Asian Paints dealer if need help)
14. How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)don't know
(_)What is paved road?
____________________
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
************************************************************************
NOTE: If you don’t 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 lisence immediately.
(Check appropriate box)
1. Last name:
(_) Yadav
(_) Sinha
(_) Pandey
(_) Mishra
(_) Don’t know
2. First name:
(_) Ramprasad
(_) Lakhan
(_) Sivaprasad
(_) Jamnaprasad
(_) Don’t know
3. Age:
(_) Less than zero
(_) Zero
(_) Greater than zero
(_) Don't know
4. Sex:
M _____ F _____ not sure! _____ Not applicable
5. Chappal Size:
Left ____ Right ______
5. Occupation:
(_) Politician
(_) Doodhwala
(_) Pehelwaan
(_) House wife
(_) Un-employed
6. Number of children living in household: ___
7. Number that are yours: ___
8. Mother's Name: _______________________
9. Father's Name: _______________________
(If not sure, leave blank)
10. Ejjucason:
1 2 3 4 (Circle highest grade completed)
11. Do you bathe?
(_) Yes (_) No (_) Not applicable
12. If yes, how often do you bathe?
(_) Weekly
(_) Monthly
(_) Yearly
13. Color of teeth:
(_) Yellow
(_) Brownish-Yellow
(_) Brown
(_) Black
(_) Others - Give exact color (call nearest Asian Paints dealer if need help)
14. How far is your home from a paved road?
(_)1 mile
(_)2 miles
(_)don't know
(_)What is paved road?
____________________
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