(Unofficial Transla�on)
NATIONAL
Ques�ons in this schedule should be asked to the Household head or to a Household (HH) member who is able to answer. Answers
should be marked by circling the number corresponding to the appropriate answer.
District ............................ V.D.C./Municipality ................................... Ward No........Enumeration Area No.......Village/Settlement/Tole ..............
Household Information
Personal Information
1. What is the type of the house occupied by the household ?
1. Own
2. Rented
3. Ins�tu�onal
4. Others ..............
Please give the first, middle
and last name of the
S.
persons who usually live in
N.
your household
2. What is the structure of the house ?
2.1 Foun- 1. Mud bonded bricks/stone 2. Cement bonded bricks/stone 2.4 No. of
da�on : 3. Concrete with pillar 4. Wooden pillar 5. Other .....
Floor
(star�ng from the head
of the household)
...........
2.2 Outer
Wall :
1. Mud bonded bricks/stone 2.Cement bonded bricks/stone
3. Wood/planks 4. Bamboo 5. Unbaked bricks 6. Other .... 2.5 How old
2.3 Roof:
1. Straw/thatch 2.Galvanized iron 3. Tile/slate
4. Concrete/cement 5. Wood/planks 6. Earth/Mud 7. Other....
is the
house ?
.......
1
4. What is the usual type of fuel used for cooking in your household ?
1. Wood 2. Kerosene 3. LP Gas 4. Cow Dung 5. Biogas 6. Electricity 7. Other .......
02 First
Name :
4. No Toilet
7. Do you have following facili�es in your household ? (Mul�ple response is possible)
1. Radio 2. TV
3. Cable TV 4. Computer
5. Internet 6. Telephone
7. Mobile Phone 8. Motor
9. Motorcycle 10. Bicycle 11. Other type of vehicle
12. Refrigerator 13. None
8. Does any female member of the HH own house in any part of Nepal ? 1. Yes
9. Does any female member of the HH own land in any part of Nepal ?
[]
2. No
1. Yes 2. No
11
10. Please tell us the area of land owned by female member ?
Unit
Bigha
Katha
Ropani
Dhur
Last
Name :
========================
========================
5. Other ........
6. What type of toilet facility are you using in your household ?
1. Flush (Public Sewarage) 2. Flush (Sep�c Tank)
3. Ordinary
Anna
Last
Name :
03 First
Name :
========================
========================
========================
Paisa
Last
Name :
Area
========================
11. Were there any deaths occured during the last 12 months in your household ?
1. Yes, Number : .............
13
2. No
04 First
12. Please give use the descrip�on of deceased persons.
S.
N.
Sex
Cause of
death
Age at
death
if deceased woman was
15-49 years of age,
Condi�on at the �me of death
1
2
1. Male
2. Female
======== yr.{ 1. Pregnant
===================
1. Male
2. Female
2. Delivery
===================
2. No
3. Deaths during 6 weeks of delivery
Personal Informa�on 3. Don't Know
1
Sex
1. Male 2. Female
Age at
leaving
(yr.)
=========
========================
Passed level Absent
dura�on
of edu. *
(yr.)
===================
=========
05 First
Name :
========================
Personal Informa�on
14. Give descrip�on of persons absent and living in other countries
S.
N.
Last
Name :
2. Delivery
13. Are any persons absent from the household living in other countries?
1. Yes
Name :
========================
3. Deaths during 6 weeks of delivery
======== yr.{ 1. Pregnant
Absent
reason/
purpose **
Des�na�on
country
=============
=======================
2
1. Male 2. Female
=========
===================
=========
=============
=======================
3
1. Male 2. Female
=========
===================
=========
=============
=======================
4
1. Male 2. Female
=========
===================
=========
=============
=======================
* Code for passed level of educa�on (5 yrs. & above only) : passed level but illiterate, SLC,
Intermediate, Diploma, PhD, should be given proper code.
** Code for reason/purpose: 1. Business 2. Personal Service 3. Ins�tu�onal Service
4. Study
5. Conflict 6. Dependent
7. Other
8. Don't Know
3
2
01 First
3. What is the main source of drinking water in your household ?
Name :
1. Tap/pipe 2. Tubewell/Hand pump 3. Covered Well/Kuwa 4. Uncovered Well/Kuwa
5. Spout water 6. River/Stream
7. Other ................
5. What is the usual source of ligh�ng in your household ?
1. Electricity
2. Kerosene
3. Biogas
4. Solar
What is
the rela�onship
of
household
head
to
(Name)?
Last
Name :
06 First
Name :
Last
Name :
========================
========================
========================
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
1.
2.
3.
4.
5.
6.
Household Head
Spouse
Son/Dau.-in-law
Dau./Son-in-law
Parent
Father/Motherin-law
7. Brother/sister
8. Grandson/G.D.
9. HH worker
10. Other ..
What
is
the sex
of
(Name)
?
4
POPULATION CENSUS 2011 - NEPAL
Sex of Household Head :
1. Male 2. Female
(Write
down
Completed
year, enter
“00” if less
than one
year)
(Name) ?
What is the
marital status
of
(Name) ?
What was
the age at
first
marriage
of
(Name)?
6
7
8
Only for
married
persons
For persons 10
years and above
1. Never Married
1. Male
================
2. Female
What is
the Religion
of
(Name) ?
9
9
3. Mul�ple spouse
=====
4. Re-married
Year
================
6. Divorced
7. Separated
1. Never Married
1. Male
9
================
2. Female
3. Mul�ple spouse
=====
4. Re-married
Year
================
5. Widow/widower
6. Divorced
7. Separated
1. Never Married
1. Male
9
Year
================
2. Female
3. Mul�ple spouse
=====
4. Re-married
Year
================
5. Widow/widower
6. Divorced
7. Separated
1. Never Married
1. Male
9
Year
================
2. Female
3. Mul�ple spouse
=====
4. Re-married
Year
================
5. Widow/widower
6. Divorced
7. Separated
1. Never Married
1. Male
9
Year
================
2. Female
3. Mul�ple spouse
=====
4. Re-married
Year
================
5. Widow/widower
6. Divorced
7. Separated
1. Never Married
1. Male
2. Female
9
Year
================
3. Mul�ple spouse
4. Re-married
5. Widow/widower
6. Divorced
7. Separated
12
Female
=====
Year
================
For persons 5 years and above
Is
Can
What is
(Name) (Name) the Level of
read and currently Educa�on
a�endwrite?
of
ing
(Name) ?
school/
college?
13
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1.
2.
2. India
3.
.................
4.
3. China
5.
2. Second Lang.
6.
4. Other .............
................
7.
8.
9.
Not disable
1. Read &
Physical disable
write
Blind and low vision
Deaf & hard of hearing 2. Read
Deaf-Blind
Only
Speech problem
Mental Illness
3. Can't
Intellectual disable
Read
Mul�ple disable
& Write
1. Mother
Tongue
2. Once married
=====
11
1. Mother
Tongue
2. Once married
=====
10
1. Mother
Tongue
2. Once married
=====
What is
the Physical
and mental
disability
of
(Name)?
1. Mother
Tongue
2. Once married
=====
Which
Country's
Ci�zen is
(Name) ?
1. Mother
Tongue
2. Once married
Year
What is
the Mother
Tongue and
Second
Language
of
(Name) ?
1. Mother
Tongue
5. Widow/widower
=====
Male
Absent (abroad)
2. Once married
Year
Total
Usually live
First and Last Name of Household Head : ........................................ ....................... Absent (within country)
What is the
Caste/
Ethnicity
of
=====
Household Members
................................ House No. ................. Household No. .....................
What is
the age
of
(Name) ?
5
Schedule 1 Contact Telephone No. .......................... Total page ...... of page ......
1. Nepal
1. Nepal
1. Nepal
1. Nepal
1. Nepal
1. Nepal
14
1. Yes
2. No
1. Yes
2. No
1. Yes
2. No
1. Yes
2. No
1. Yes
2. No
1. Yes
2. No
15
1. Pass level
................
2. Major Sub.
(above SLC)
..................
1. Pass level
................
2. Major Sub.
(above SLC)
..................
1. Pass level
................
2. Major Sub.
(above SLC)
..................
1. Pass level
................
2. Major Sub.
(above SLC)
..................
1. Pass level
................
2. Major Sub.
(above SLC)
..................
1. Pass level
................
2. Major Sub.
(above SLC)
..................
NATIONAL POPULATION
(Unofficial Transla�on)
District ............................ V.D.C./Municipality ................................... Ward No........Enumeration Area No.......Village/Settlement/Tole ..............
Ques�ons in this schedule should be asked to the Household head or to a Household (HH) member who is able to answer.
Please write down these informa�on from form 1
What
What
is
is the
The first and middle
N.
age
name of the persons the sex
of
of
who usually live in
(Name)
(Name)
the household
?
?
S.
1
01
2
4
5
What is
the marital
status
of
(Name) ?
7
2. Once married
3. Mul�ple spouse
2.Female
========
4. Re-married
7. Separated
1. Never Married
2. Once married
1.Male
3. Mul�ple spouse
2.Female
========
4. Re-married
7. Separated
1. Never Married
2. Once married
1.Male
3. Mul�ple spouse
2.Female
========
4. Re-married
7. Separated
1. Never Married
2. Once married
1.Male
3. Mul�ple spouse
2.Female
========
4. Re-married
7. Separated
1. Never Married
2. Once married
1.Male
3. Mul�ple spouse
2.Female
========
4. Re-married
7. Separated
1. Never Married
2. Once married
1.Male
3. Mul�ple spouse
2.Female
3. Service
..............................
====
1. V.D.C.
Year
3. Other country
1. Same Dist.
====
1. V.D.C.
Year
5. Marriage
6. Dependent
7. Conflict
3. Other country
..............................
1. Same Dist.
8. Others ......
19
2. Other District
..............................
====
1. V.D.C.
Year
3. Other country
..............................
1. Same Dist.
19
2. Other District
..............................
====
1. V.D.C.
Year
3. Other country
..............................
1. Same Dist.
19
2. Other District
..............................
====
1. V.D.C.
Year
========
4. Re-married
3. Other country
..............................
1. Same Dist.
..............................
5. Widow/widower 2. Municipality
6. Divorced
7. Separated
19
2. Other District
1. V.D.C.
3. Other country
..............................
4. Study
====
Year
Have
(Name)
had any
live births
during
the last
12 months ?
What work
(Name)
usually did
during the last
12 months ?
21
22
2. No
Descrip�on
Son
22
Dat.
1. Yes
Sex
2.Dat.
3. Other country
3.Dead
1.Son
..............................
4.Total
2.Dat.
1. Same District
2. Other District
..............................
1. Yes
2. No
Descrip�on
Son
22
Dat.
1. Yes
Sex
1.Living together
1.Son
2.Living sep.
2.Dat.
3. Other country
3.Dead
1.Son
..............................
4.Total
2.Dat.
1. V.D.C.
2. Municipality
1. Agriculture
2. Business
3. Service
4. Study
5. Marriage
6. Dependent
7. Conflict
8. Others ......
1. Same District
1. Agriculture
2. Business
1. Same District
2. Other District
..............................
1. V.D.C.
2. Municipality
3. Other country
..............................
2. Other District
..............................
1. V.D.C.
2. Municipality
3. Other country
..............................
2. Other District
..............................
1. V.D.C.
2. Municipality
3. Other country
..............................
1. Same District
2. Other District
..............................
1. V.D.C.
2. Municipality
3. Other country
..............................
1. Yes
2. No
Descrip�on
Son
22
Dat.
1.Living together
1. Yes
Sex
2.Dat.
3.Dead
1.Son
2.Dat.
4.Total
2. No
Descrip�on
Son
22
Dat.
1. Yes
Sex
1.Living together
1.Son
2.Living sep.
2.Dat.
3.Dead
1.Son
2.Dat.
4.Total
(Describe the
actual work
done.
eg. teaching, high school
teacher)
What was
the status of
employment
of
(Name the establishment
(Name)
?
or the organiza�on where
Where did (Name)
work ?
(Industry)
worked.
eg. own land, paddy
produc�on)
Year Month
==== ======
==== ======
2. No
22
Year Month
==== ======
==== ======
2. No
22
Year Month
==== ======
==== ======
2. No
22
Year Month
==== ======
==== ======
1. Agriculture
...... months
2. Salary/Wage
...... months
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
...... months
1. Agriculture
...... months
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
=======================
=======================
16 yrs.)
=======================
=======================
=======================
=======================
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
...... months
...... months
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
...... months
2. No
Descrip�on
Son
22
Dat.
1. Yes
Sex
1.Living together
1.Son
2.Living sep.
2.Dat.
3.Dead
1.Son
2.Dat.
4.Total
1. Yes
2. No
Descrip�on
Son
1.Living together
22
Dat.
1. Yes
Sex
2. No
22
Year Month
==== ======
==== ======
2. No
22
Year Month
1.Son
2.Living sep.
2.Dat.
3.Dead
1.Son
2.Dat.
==== ======
==== ======
1. Agriculture
...... months
2. Salary/Wage
...... months
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
...... months
1. Agriculture
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7. Others ...........
worker
1. Mother/Father
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7.
Others
...........
worker
1. Mother/Father
2. Mother
...... months
3. Own Eco. Enterpr.
...... months
4. Extended Eco
...... months
5. Seeking Work
...... months
6. Household work
...... months
7. Study (Student)
...... months
8. No work
...... months
Total 12 months
2. Mother
3. Father
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
8. Others .................
3. Father
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
1. Employer
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7. Others ...........
worker
1. Mother/Father
2. Mother
3. Father
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
8. Others .................
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7. Others ...........
worker
1. Mother/Father
2. Mother
3. Father
1. Employer
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7.
Others
...........
worker
1. Mother/Father
2. Mother
3. Father
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
8. Others .................
1. Student
2. House work
3. Aged
2. Employee
4. Pension
3. Own account 5. Physically & mentally
handicapped
worker
6. Sickness or chronic
illness
4. Unpaid family
7. Others ...........
worker
1. Mother/Father
2. Mother
3. Father
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
8. Others .................
1. Employer
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
=======================
Total 12 months
...... months
2. Salary/Wage
27
@&
8. Others .................
Total 12 months
...... months
2. Salary/Wage
26
1. Employer
...... months
...... months
Q 22: (1+2+3+4+5) < 6
25
1. Employer
Total 12 months
...... months
2. Salary/Wage
1. Agriculture
24
Total 12 months
...... months
2. Salary/Wage
1. Agriculture
23
What was the
What is the living
reason for
arrangment of
usually not
(Name) ?
working during the
(Encircle one of the
last 12 months
appropriate codes for
by (Name) ?
children less than
Total 12 months
1. Yes
4.Total
2. No
22
1.Son
2.Living sep.
1. Yes
What work (Name)
usually was done ?
(Occupa�on)
Q 22: (1+2+3+4) > 0
2.Living sep.
1. Same District
1. Agriculture
2. Business
3. Service
4. Study
5. Marriage
6. Dependent
7. Conflict
8. Others ......
1. Yes
Only for Children
below 16 yrs. of age
Ques�ons are asked to persons 10 years of age and above
(15-49 yrs. of age)
1.Son
1. Agriculture
2. Business
3. Service
4. Study
5. Marriage
6. Dependent
7. Conflict
8. Others ......
3. Service
4. Study
5. Marriage
6. Dependent
7. Conflict
8. Others ......
Only for married women
1.Living together
2. Municipality
2. Business
3. Service
..............................
..............................
5. Marriage
6. Dependent
1. Agriculture
2. Other District
2. Other District
1. V.D.C.
8. Others ......
19
1. Same District
Answers should be marked by circling the number corresponding to the appropriate answer.
20
19
4. Study
7. Conflict
..............................
5. Widow/widower 2. Municipality
6. Divorced
06
2. Other District
5. Widow/widower 2. Municipality
6. Divorced
05
(State all children
live born by sex)
18
1. Agriculture
2. Business
19
5. Widow/widower 2. Municipality
6. Divorced
04
1. Same Dist.
5. Widow/widower 2. Municipality
6. Divorced
03
17
16
5. Widow/widower 2. Municipality
6. Divorced
02
For persons 5 years Only for married women
and above
(15-49 yrs. of age)
How many children
Where was
were ever born to
(Name)
lived
(Name) ?
5 yrs ago ?
Total page ...... of page ......
Schedule 2
House No. of Form 1...........Household No. of Form 1 ................. Total Usually Living Household Members ........... Male ........ Female .........
Personal Information
year; enter
or other country the "00" if less
name must be
than
specified)
1 year)
1. Never Married
1.Male
Only for code 2 and 3 in
Ques�on 16
How long
What is the
Where is the
(Name)
main reason of
birth place of
has been
staying in
(Name) ?
staying
this district
here ?
(Code must be
of
encircled, if the place (Write down
completed
(Name)
?
of birth is other dist.
CENSUS 2011 - NEPAL
1. Employer
4. Father & Step.
Mother
5. Mother & Step
Father
6. Other rela�ve
7. Employer
8. Others .................