1985 September1-199/kloc-0 attended XXX primary school on July 28th, and the witness was XXX.

1991September1-1July 994 10 studied in XXX middle school, with reference to XXX.

1September 9951-1July 999 10 attended high school in XXX middle school, with reference to XXX.

Then fill in if you are a student, when did you go to junior high school or high school until now? For example, you can fill in 1 September 9951till now.

Your family members fill in your parents, work address and party.

(regiment) member.