NOTE: Please do not soot the person at the applikason
kounter.

He will give you the licen.

For instruksons, see bottom applikason :

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. read #7 agan & anser here: ___

9. Mather name: _______________________

10. Phather Name: ____________________ (dont 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.)

PLEASE 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 !!!!!!!!