I'm not sure what your asking? What the sql statement would look like? Or are you asking someone how the whole page is going to work and essentially write your script for you? If it's just a simple sql question, then after you submit the page, you would have something that looked like:
$SQL = "insert into DatabaseName (Name, A1A1, A1A2, etc) values ("$POST['Name']", "$POST['A1A1']", "$_POST['A1A2']", etc)";
You may want to rethink your datbase design assuming your going to have a static number of questions.. Having:
name varchar(100)
question_no varchar(5)
question_value varchar(1)
would result in alot of redundant data. If you had one user and 100 questions, you'd end up with 100 rows, each with a column with that persons name in it. In my example above, the persons name and all the answers will get stored in a single row.