[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


Office -----

Date -----

Number -----

Enclosure -----


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.


1- Name


Father’s name

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