Literal question
<span class="em">11. If</span><div class="i1">[] 1 Deaf and dumb,<br />[] 2 Blind,<br />[] 3 Lunatic, imbecile or idiot</div><p>Write the precise infirmity if any, opposite the name of the person and if the infirmity dates from childhood, add "from childhood". Do not use such a general term as "Afflicted" or "Infirm".