Annex II 97 Serial No.____ (Act of Law 7) State/Division Township ----------------Police Station Township/Village ---------------------Ward Building No. House No. Flat No. Room No. _________ _________ _________ _________ Place -------Road 1. Household No. _________________________ 2. Name__________________________________ 3. Father’s Name/Identity No. ______________ And full address ________________________ 4. Mother’s Name/Identity No. ______________ And full address_________________________ 5. Father’s elder Brother, young brother, elder sister, young sister and their address (a) _________________________ (b) _________________________ (c) _________________________ (d) _________________________ (e) _________________________ (f) _________________________ (g) _________________________ 6. Mother’s elder Brother, young brother, elder sister, young sister and their address (a) _________________________ (b) _________________________ (c) _________________________ (d) _________________________ (e) _________________________ (f) _________________________ (g) _________________________ 7. Male/Female: _______________________________________ 8. Born year ( ), ( ) month ( ) day 9. Full address of birth place: ____________________________ 10. Race: _______________________________________________ 11. Religion: ____________________________________________ 12. Indigenous citizen or foreign _________________________ 13. Identity Card No. or Foreigner Registration Card No: _____ 14. Current Occupation: __________________________________ 15. Proficient profession: _________________________________ 16. Have you before or currently serving under any military forces (Army, Air, Navy) or reserved forces? __________________________________________________________________________ 17. Health Condition: _____________________________________ 18. Education Qualification:________________________________ 19. Married (Yes/No), if yes, spouse’s name and full address___ 20. Household leader (Yes/No): :____________________________ 21. Adopted:_____________________________________________