[Translator’s notes appear in square brackets]

[Personal information has been redacted.]



Islamic Republic of Iran

Ministry of Culture and Higher Education

Educational Assessment and Evaluation Organization


In His Exalted Name

Date: 18/10/1373 [8 January 1995]

Number: 11/21015



Write your initials here: S. M.

Mr. Lian Samandari


We acknowledge receiving your registration documents for the national entrance exams for the academic year 1374-75 [1995-96]. This is to notify you that because you have not indicated your religion in Section12 of the application form, [you are required] to do so by placing an (X), and forward this form by 30/11[19 February] to the following address: Tehran, P.O. Box 15875, 1365 Educational Assessment and Evaluation Organization, File Adjustments. In case of delay or non-compliance your files will be cancelled.

1. Islam

2. Jewish

3. Christian

4. Zoroastrian

(The remembrance of God soothes the hearts)

[official stamp]

My religion is other than one of the four specified above (Baha'i). However, for religious studies, I will take the examination in Islamic studies.

With utmost respect,

Lian Samandari

Candidate's place for signature: