294 Life and Letters of Francis Galton 



For Private Information only. 

 QUESTIONS A, CONCERNING THE KINDRED OF THE APPLICANT. 



On the Fraternity consisting of the Applicant and of his whole Brothers and Sisters. 

 Write A hy the side of the figure in the first column that refers to the Applicant. 



We certify that to the best of our knowledge the above account is correct, also that with 

 the exceptions mentioned below, no member of this Fraternity has ever suffered from Insanity, 

 Epilepsy or other severe form of nervous disease. 



Exceptions giving full particulars. If no 

 exceptions write the word "None " 



f Writer of the above notice. 

 Signatures of ■< _, . ,. 



[The Applicant. 



The last paragraph and the corresponding paragraphs of Questions B and C must be on 

 a separate sheet marked "confidential." F. G. 



QUESTIONS B, CONCERNING THE KINDRED OF THE APPLICANT. 



On the Fraternity consisting of the Father of the Applicant and of the Father's whole 

 brothers and sisters. Write F by the side of the figure in the first column that refers to the 

 Father, and describe his achievements more fully than those of his brothers. 



