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1. Personal Details (व्यक्तिगत विवरण )
3. Where were you at the time of Earthquake?(तपाई त्यो समयमा कहां हुनुहुन्थ्यो ?)
15. Was the intensity of shock strong enough to have the following effects outside the house ? (घरदेखि बाहिर कस्तो भौतिक असरहरु परेको देख्नुभयो ?)