[PROVISIONAL TRANSLATION FROM Persian]
[Translator’s notes appear in square brackets]
[Personal information has been redacted.]
Islamic Republic of Iran
Ministry of Education
General Office of the Department of Education, Tehran Province
In the Name of God
It is essential to answer the questions with utmost honesty.
Birth certificate number
Date of birth
Baha’i Registration number
2- Are your parents Baha’is?
3- Are you a follower of the Baha’i sect?
4- How many years have you been following this Faith?
5- Do you discuss your beliefs in your school classes?
6- Which of your close relatives and friends are followers of Baha’i sect?
7- Are you ready to recant this Faith?
8- Write any other information you deem necessary
Place of signature