DERIVING LICENSE APPLIKASON
NOTE: Please do not soot the person at the applikason kounter.
He will give you the licen.
If you dot know how to fill ,copy from your phriend (dost)applikason.
For phurthar instructions, see bottom applikason.
1. Last name:
(_) Yadav (_) Sinha (_) Pandey (_) Misra (_) Don’t no
(Check karet box)
2. Phust name:
(_) Ramprasad (_) Lakhan (_) Sivprasad (_) Jamnaprasad (_) Don’t no
(Check karet box)
3. Age:
(_) Less than phipty (_) Greater than phipty (_) Don’t no
(Check karet box)
4. Sex: ____ M _____(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 yourj: ___
9. Mather name: ____________ _________ __
10. Phather Name: ____________ ________ (If not no,leabe blank)
11. Ejjucason: 1 2 3 4 (Circle highest kilass attended)
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, pleaje do not copy thumb impression also. Pleaje
Provide your own thumb impression.)
NOTE: PELEAJE DO NOT USE PHINGERS OF YOUR LEGS
Use thumb on your lepht hand only. If you don’t have Le pht 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 DERIVE.
WE ARE VARY ISTRICT ABOUT THIS.