फर्मनि थाखाय बेखौल' गोनांथि दि नोंथाङा जाय मुंखौ बाहायगासिनो आरो जाय अक्ट'खौ नोंथाङा बाहायनो जागायजेनदोंमोन, लोगोसे गावनि आरो गावनि फालांगिनि सोमोन्दै गुदि फोसावथाइखौ फारिलाइ खालाम।
The form simply requires you to list the name you're using and the date you started using it, as well as basic information about yourself and your business.