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1
Personal details-
Name: - _________________________________________
1. Gender
a) Male
b) Female
2. Age Group
a) Below 21 Years
b) 21 years – 30 years
c) 31 years – 40 years
d) 41 years – 50 years
e) Above 50 years
3. Occupation
a) Govt. Job
b) Private Job
c) Business
d) Other (specify)