For all persons, regardless of age:
18a. If you have an impairment or permanent physical disability, please state it here:
____
Examples: blind, almost blind, deaf-mute; characterized deafness [surdite caracteriseee]. For Amputation, maiming [mutilation], paralysis: please specify. For other impairment: please specify.
18b. Is it the result of:
[] 1 A war injury
[] 2 A work accident
[] 3 Other accident
[] 4 Illness or other reason
18c. If necessary, indicate the corresponding percentage of disability: ____ %