6. Month and year of birth
Month
[] January to May
[] June to December
Year of birth
Decade
Fill one circle only
[] 186_
[] 187_
[] 188_
[] 189_
[] 190_
[] 191_
[] 192_
[] 193_
[] 194_
[] 195_
[] 196_
[] 197_
Actual year
Fill one circle only
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9