Before commencing this FORM APPLICATION QUESTIONNAIRE (Indicate in the block provided) Please turn to the BACK LAST PAGE END (Indicate in the block provided) To UNDERSTAND KNOW (Indicate in the block provided)more about it.

THANK YOU DANKIE DANKE (Indicate in the block provided) for YOUR OUR THEIR (Indicate in the block provided) CO-OPERATION NON CO- OPERATION HELP NOTHING. (Indicate in the block provided)

Instructions: Please complete the following section piece (Indicate in the block provided) if you are of the age group 1 month to 40 years:

1. YOUR SURNAME:
   
2. YOUR FIRST NAME:
   
3. YOUR ADDRESS:
   
4. YOUR AGE AT LAST BIRTHDAY:(y/m)
   
5. SEX:(m/f/y/n)
   

1. If your answer to Question 3 is "No fixed abode" or "nowhere" Please state say (Indicate in the block provided) where you are staying at night after hours (Indicate in the block provided). If your answer to question 3 is "Motor car" or "motor vehicle" or "truck" please state the model type (Indicate in the block provided) and year.
2. If your answer to Question 5 was "yes" or "no" or "twice a week" or anything other than "male" or "female" please refer to Appendix D.
3. If your answer to question 4 is "41 years" or "42 years" or anything other than an age under 40 years then you are completing filling deleting that which is not applicable (Indicate in the block provided) in the wrong section. Please proceed to section A (2) or section A (3).
4. If your answer to question 4 was "I don't know" please read Note 1 at the end of this questionnaire.
5. At this stage part section point (Indicate in the block provided) if you are happy glad pleased (Indicate in the block provided) with this section you may now proceed to section A (2), and section A (3) and indicate that each section is not applicable by indicating showing ruling out deleting that which is not applicable writing "Not applicable" (Indicate in the block provided) in the applicable not applicable (Indicate in the block provided) spaces fields gaps (Indicate in the block provided) provided. Then continue to section B (1)

Please complete the following section piece (Indicate in the block provided) if you are of the age group 41 years to 100 years:

1. YOUR SURNAME:
   
2. YOUR FIRST NAME:
   
3. YOUR ADDRESS:
   
   1. If your answer to question 3 is "No fixed abode" or "nowhere" Please state say (Indicate in the block provided) where you are staying at night after hours (Indicate in the block provided)
   2. If your answer to question 3 is "Motor car" or "motor vehicle" or "truck" please state the model type (Indicate in the block provided) and year.
   _.
4. YOUR AGE AT LAST BIRTHDAY:(Y/M)
   
5. SEX:(M/F/Y/N)
   

1. If your answer to question 4 is "100 years" or "39 years" or anything other than an age between 41 and 100 years then you are completing filling Deleting which is not applicable (Indicate in the block provided) the wrong section. Please go to section A (1) or section A (3). If your answer to question 4 was "I don't know" please read Note 1 at the end of this questionnaire form. (Indicate in the block provided)
2. If your answer to Question 5 was "yes" or "no" or "twice a week" or anything other than "Male" "Female" (Indicate in the block provided) please refer to Appendix D.
3. At this stage part section point (Indicate in the block provided) if you are happy glad pleased (Indicate in the block provided) with this stage section part point (Indicate in the block provided) you may now proceed to section A (3), and section A (1) and indicate that each applicable section is not applicable by Deleting which is not applicable scoring out indicating showing writing `Not applicable' (Indicate in the block provided) in the space field gaps (Indicate in the block provided) provided. Then continue to section B (1]

Please complete the following section piece (Indicate in the block provided) if you are over the age of 100 years:

1. YOUR SURNAME:
   
2. YOUR FIRST NAME:
   
3. YOUR ADDRESS:
   
4. YOUR AGE AT LAST BIRTHDAY:(Y/M)
   
5. SEX:(M/F/Y/N)
   
6. HOW DO YOU DO IT:
   

1. If your answer to Question 5 was yes no twice a week (Indicate in the block provided) or anything other than "Male" or "Female" please refer to Appendix D.
2. If your answer to question 3 is "No fixed abode" or "nowhere" Please state say (Indicate in the block provided) where you are staying at night after hours (Indicate in the block provided) . If your answer to question 3 is "Motor car" or "motor vehicle" or "truck" (Indicate in the block provided) please state the model type (Indicate in the block provided) and year.
3. If your answer to question 3 is "one foot" or "appendage" in the grave please indicate which foot appendage (Indicate in the block provided) . If you have a false leg appendage (Indicate in the block provided) please state so and indicate which one it is. Also include name of grave tomb coffin mausoleum (Indicate in the block provided) .

4. If your answer to question 4 is "99 years" or anything other than an age under 100 years then you are completing filling in (Indicate in the block provided) the wrong section. Please go to section A (1) or section A (2). If your answer to question 4 was "I don't know" please read Note 1 at the end of this questionnaire.
5. At this stage part section point (Indicate in the block provided) if you are happy glad pleased (Indicate in the block provided) with this section you may now proceed to section A (1), section A (2) and indicate that each applicable section is not applicable by indicating showing ruling out deleting/writing "Not applicable" (Indicate in the block provided) in the applicable spaces fields gaps (Indicate in the block provided) provided. Then continue to section B (1)

Here We I Us Them Whoever (Indicate in the block provided) would like to know a few personal particulars. Please indicate show clarify (Indicate in the block provided) your answer by means of a yes no x aye nay nee pass don't know (Indicate in the block provided) in the applicable space provided.

1. DO YOU FEEL THAT YOU
   • CAN
   • WILL
   • MIGHT
   • MUST
   • SHALL NOT
   CONTRIBUTE TO THE ESTABLISHMENT WELL-BEING (Indicate in the block provided) OF THIS POLITICAL PARTY?
2. ARE YOU INTERESTED IN
   • POTJIEKOS
   • HAMMERS AND SICKLES
   • RUGBY
   • TRADITIONAL WEAPONS
   • KHAKI CLOTHING
   • BLOEMFONTEIN
   • SLAUGHTERING BULLS IN YOUR BACK YARD
   
   
3. ARE YOU A MEMBER OF ANY OF THE FOLLOWING SOCIETIES ORGANISATIONS (Indicate in the block provided) (Please indicate by marking ticking indicating in (Indicate in the block provided) the block provided.
   • AWB
   • ANC
   • CNA
   • SABC
   • SPCA
   • SA RUGBY BOARD
   • WIT WOLVE TIERE WURMS HASE (Indicate in the block provided)
   • OTHER
   • NONE OF THE ABOVE
   • ALL OF THE ABOVE

1. If the answer to Section B, question 3 is `other' or `none of the above' please refer to Appendix C.
2. Having successfully/unsuccessfully (Delete which is not applicable.) completed section B please turn to section C.

In this section we us I them (Indicate in the block provided) would like you she her he it (Indicate in the block provided) to complete a few simple easy difficult (Indicate in the block provided) general colonel major (Indicate in the block provided) knowledge questions so that we can see whether you could fit in with such superior beings beans(Indicate in the block provided) like ourselves.

1. WHAT IS YOUR NAME?
   
2. IF x = 9, HOW MUCH IS y EQUAL TO?
   
3. WHO HOLDS THE WORLD BICYCLE EATING RECORD?
   
4. WHO CROSSED THE ATLANTIC OCEAN IN AN PAPERBAG?
   
5. WHAT SHAPE IS THE EARTH?
   

1. If your answer to question 5 was anything other than "round" please complete Section C question 3 and Appendix F
2. Having successfully unsuccessfully (Indicate in the block provided) completed Section C. we would like you to answer a few marketing questions. Please continue onto Section D.

1. HOW OLD ARE YOU?
   
2. HOW DID YOU FIND THIS QUESTIONNAIRE?
   • EASY
   • COMPLETED
   • BEHIND YOUR POTATOES
   • IN THE POST-BOX
3. ARE YOU SHOCKED BY THE CONTENTS OF THIS QUESTIONNAIRE?
   • YES
   • NO
4. ARE YOU STILL INTERESTED DISINTERESTED (Indicate in the block provided) IN SETTING FIRE TO SLEEPING WITH LAUGHING AT (Indicate in the block provided) THIS POLITICAL PARTY?

1. If your answer to Question 1 was "unsure" or "none of the above" or "over 101 years" please refer to section A.
2. If your answer to question 3 was "yes" please state whether physically mentally electrically. (Indicate in the block provided)
3. If your answer to question 4 was "yes" please continue on to section F.
4. If your answer to question 4 was "no" please continue on to Appendix 4.

Having completed this section and read all the instructions, please complete section E

We would appreciate like require want order (Indicate in the block provided) some further more (Indicate in the block provided) information about your previous work job career (Indicate in the block provided) . Please complete fill in (Indicate in the block provided) all the questions requests (Indicate in the block provided) as truthfully untruthfully (Indicate in the block provided)

1. ARE YOU CAPABLE OF OPERATING BREAKING EATING (Indicate in the block provided) ANY OF THE FOLLOWING? (Indicate in the block provided by means of a tick mark splat blob (Indicate in the block provided) any that are not applicable)
   1. ANVIL
   2. SHOE
   3. ELVIS
   4. BRICK
   5. WIFE
   6. HUSBAND
   7. MOTHER-IN-LAW
   8. GUN
   9. BEER BRANDY WINE
   10. BOTTLE
   11. POLITICAL PARTY
   12. BROOM
   13. KNIFE FORK SPOON
   14. SMALL STUFFED TOY RABBIT
   15. FORD
   16. BOMB
   17. AK47
   18. GRAVE
   19. NONE OF THE ABOVE
   20. ALL OF THE ABOVE
2. HAVE YOU EVER BEEN DECLARED
   1. INCOMPETENT
   2. INCORRIGIBLE
   3. HOPELESS
   4. BLOODY STUPID
   5. INCAPABLE IN ANY OTHER WAY FASHION MANNER?

1. If your answer to Section E Question 1 was "None" or "all" please refer to Appendix E.
2. If your answer to Section E Question 2 was "other" Please explain elaborate (Indicate in the block provided) in the space field gap area (Indicate in the block provided) provided below.
   
   
3. Having successfully completed section E, please continue go on complete (Indicate in the block provided) Section F.

Please complete if your answer to Section D Question 4 was "Yes" and having completed Section E.

Please remember that false information constitutes fraud and I am sure your mommy would not like to find out you lied!!!!

I Me Us Them Whoever (Indicate in the block provided) do hereby agree disagree laugh at concur (Indicate in the block provided) with all the conditions set for joining this obscure political party. Furthermore I Me Us Them Whoever (Indicate in the block provided) have fully understood all this hogwash that I have tried to complete.

SIGNED: DATE:

Before completing this Appendix please refer to NOTE 1.

1. YOUR DATE OF BIRTH:
   (If you are unsure of this please complete question 1 (a).
   1. YOUR APPROXIMATE DATE OF BIRTH:
      (If you are unsure of this please complete question 1 (b).
   2. WERE YOU BORN THIS CENTURY?
      If the answer to question 1 (b) was "I don't know" or "no" or "I think so" (Indicate in the block provided) please answer question 1 of Appendix B. If you have successfully completed Appendix A then please proceed to Section 2.

If the answer to Section A (1), (2) or (3) Question 5 was anything other than "Male" or "Female" then please complete this Appendix.

1. WHAT ARE YOU?
   Please enclose a photograph showing all the necessary anatomical details. Clearly mark your application "WEIRDO."

If your answer to Section E Question 1 was "None" then what can you operate break eat (Indicate in the block provided)? (please indicate show (Indicate in the block provided) in the space gap field (Indicate in the block provided) provided.
If your answer to Section E question 1 was "All" then you should really go see a doctor!

If your answer to Appendix C Question 3 was "Yes" please complete the following:

1. HOW MUCH MONEY DO YOU HAVE?
   
2. WHERE IS IT KEPT?
   
3. WHAT IS YOUR BANK ACCOUNT/PIN NUMBER?
   

If you have not been able to complete Appendix B please take your sandwiches bicycle comic books (Indicate in the block provided) and go home.

If you are unable to complete any of the three questions of appendix F please take your bicycle comic book sandwiches (Indicate in the block provided) and go home, we have just remembered there are plenty of other suckers charlies (Indicate in the block provided) who would like to join us. Thank you and good night.

Please remember that we us them a few of us (Indicate in the block provided) will endevour try to might (Indicate in the block provided) keep all information drivel garbage life histories(Indicate in the block provided) secret not secret confidential (Indicate in the block provided)

If you believe that we us I (Indicate in the block provided) have a bridge castle statue (Indicate in the block provided) to sell you them (Indicate in the block provided)

Print out and then fold this questionnaire very carefully and place in a self addressed stamped envelope, enclosing a R50-00 note and post to: