DRIVING LICENSE APPLICATION FORM
NOTE: Please do not shoot the person at the application counter.
He will give you the license. For further instructions, see the bottom of the application.
1. Last name:
(_) Yadav (_) Sinha (_) Pandey (_) Misarwa (_) Do not know
(Check correct box)
2. First name:
(_) Ramparsad (_) Lakhanva (_) Sivparsad (_) Jamnaparsad (_) Do not know
(Check correct box)
3. Age:
(_) Less than fifty (_) Greater than fifty (_) Do not know
(Check correct box)
4. Sex: ____ Male_____ Female (F) _____ not sure _____not applicable
5. Chappal Size: ____ Left ____ Right
6. Occupation:
(_) Politician (_) Milkman (_) Shopkeeper (_) Housewife (_) Unemployed
(Check correct box)
7. Number of children living in the household: ___
8. Number that are yours: ___
9. Mother's name: _______________________
10. Father's Name: ____________________ (If not known, leave blank)
11. Education level: 1 2 3 4 (Circle highest grade completed)
12. Dental record:
(_) Yellow (_) Brownish-yellow (_) Brown (_) Black (_) Other -__________ Give exact color
(Check correct box)
13. Your thumb impression:
____________________________
(If you are copying from another application form, please do not copy the 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 don't have a left hand, use your thumb on the right hand. If you do not have a right hand, use the thumb on the left hand.
NOTE: IF YOU DON'T HAVE BOTH HANDS, YOU CANNOT DRIVE.
WE ARE VERY STRICT ABOUT THIS.
NOTE: Please do not shoot the person at the application counter.
He will give you the license. For further instructions, see the bottom of the application.
1. Last name:
(_) Yadav (_) Sinha (_) Pandey (_) Misarwa (_) Do not know
(Check correct box)
2. First name:
(_) Ramparsad (_) Lakhanva (_) Sivparsad (_) Jamnaparsad (_) Do not know
(Check correct box)
3. Age:
(_) Less than fifty (_) Greater than fifty (_) Do not know
(Check correct box)
4. Sex: ____ Male_____ Female (F) _____ not sure _____not applicable
5. Chappal Size: ____ Left ____ Right
6. Occupation:
(_) Politician (_) Milkman (_) Shopkeeper (_) Housewife (_) Unemployed
(Check correct box)
7. Number of children living in the household: ___
8. Number that are yours: ___
9. Mother's name: _______________________
10. Father's Name: ____________________ (If not known, leave blank)
11. Education level: 1 2 3 4 (Circle highest grade completed)
12. Dental record:
(_) Yellow (_) Brownish-yellow (_) Brown (_) Black (_) Other -__________ Give exact color
(Check correct box)
13. Your thumb impression:
____________________________
(If you are copying from another application form, please do not copy the 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 don't have a left hand, use your thumb on the right hand. If you do not have a right hand, use the thumb on the left hand.
NOTE: IF YOU DON'T HAVE BOTH HANDS, YOU CANNOT DRIVE.
WE ARE VERY STRICT ABOUT THIS.