Shakti's Applikason Phorom..jokes..read it.

1. Last name:

(_) Yadav (_) Sinha (_) Pandey (_) Misra (_) Dot no

(Check karet box)

2. First name:

(_) Ramprasad (_) Lakhan (_) Sivprasad (_) Jamnaprasad (_) Dot no

(Check karet box)

3. Age:

(_) Less than phipty (_) Greater than phipty (_) Dot no

(Check karet box)

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

5. Chappal Size: ____ Lepht ____ Right

6.Occupason:

(_) Politison (_) Doodhwala (_) Pehelwaan (_) House wife (_) Un-employed

(Check karet box)

7. Number of children libing in the household: ___

8. Number that are yours: ___

9. Mather name: _______________________

10. Phather Name: ____________________ (If not no,leave blank)

11. Ejjucason: 1 2 3 4 (Circle highest grade completed)

12. Dental rekard:

(_) Ellow (_) Berownish-ellow (_) Berown (_) Belack (_) Other -__________ Give egjhakt color

(Check karet box)

13.Your thumb imparesson :
____________________________

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

PELEASE DO NOT USE PHINGERS OF YOUR LEGS

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

NOTE : IF YOU DONT HAVE BOTH HANDS, YOU CANNOT DRIVE.

WE ARE VARY ISTRICT ABOUT THIS