[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[The questionnaire form for the General Tire and Rubber Company of Iran for identifying the religion of the employees of the company and separate questions for investigating the Baha’i employees]

 

The General Tire and Rubber Company

In the Name of God

 

Row number: ---

Special Personnel questionnaire

 

Respected colleagues are required to provide correct answers to the points below

 

Name –------

Family name -----

Name of father -------

Birth certificate number -------

Date of birth --------

Date of Employment ---------

Marital status and dependents ------

Exact place of residence -------

Military service status:

Year of completion -----

Medical exemption ------

Guardianship exemption -----

Redundant

Others -----

 

Follower of the religions

  1. Islam
  2. Christianity
  3. Judaism
  4. Zoroastrianism

 

Or

Baha’i Sect 

In case of being a Baha’i, declaration number ---- Place of declaration ------ to be accurately mentioned.

 

Prior to employment by the company you were working in, where were you and what have you been doing. ---------- and ------------

 

Reasons for leaving the last job:

You were expelled ------ resigned ------   optional -------   clear reason --------

 

In case of being illiterate, it is required to mention the name and family name of the person who completed this sheet.