Manipuri to English:
ꯐꯣꯔꯝ ꯑꯗꯨꯗ ꯅꯪꯅ ꯅꯪꯒꯤ ꯍꯥꯟꯅꯗꯒꯤ ꯂꯩꯔꯛꯂꯕ ꯑꯅꯥꯕꯁꯤꯡꯒꯤ ꯃꯇꯥꯡꯗ, ꯀꯔꯤꯒꯨꯝꯕ ꯂꯩꯔꯕꯗꯤ, ꯈꯪꯍꯟꯒꯗꯕꯅꯤ꯫
You will have to declare about your pre-existing diseases if any in the form.