[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

 

In the Name of God, the Exalted

Questionnaire

Especially for the Headquarters of the Cultural Revolution

 

[Emblem]

Islamic Republic of Iran

Headquarters of the Cultural Revolution

 

[The Headquarters of the Cultural Revolution questionnaire, requests various information in a number of sections -such as personal, educational and occupational details of the individual. In the first section of the form, question eight queries the applicant’s religion]