CONFIDENTIAL
Republic of Namibia
Namibia 2011 Population and Housing Census
Special Population Groups
Form B1
Region Code
Section
U/R
Constituency
Code
Form Number
Form ......of .........
DU Number
EA Code
Type of special
population code
for 303,304,305 leave blank
A
Female
Total
Male
Name of the Institution/Place:
Sex
Names
Person Line Number
B1
List the names of all persons
found in this Institution/Place on
the Census reference night
Age
Citizenship
Are you female or How old were you What is your
male?
on your
citizenship?
last birthday?
F= Female
M= Male
If less than one
year enter 00,if 95
years and above
enter 95
B4
B5
Place
If in Namibia write region,constituency
and Locality or if outside Namibia,
write country name in the space
provided below
Enter 99 for don’t Enter codes from
know
code list 1
B2
Birth
Where was your mother usually
living when you were born?
The coder will enter the codes from code
list 2 in the boxes provided
B9
B11
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Types of Special Population:
301 Police Holding Cells
302 Hospital in-patient
303 Travellers
304 Homeless
305 Fishermen
Usual Residence
Where do you usually live?
If in Namibia write region, constituency
and Locality or if outside Namibia,
write country name in the space
provided below
The coder will enter the codes from code
list 2 in the boxes provided
B12
COMMENT BOX
Person Line Column
Number
Number
!"#$%&$'$())#*+,'-(.'+/#'.#,"(*,#,
FOR OFFICE USE ONLY
FIELD STAFF
ENUMERATOR
Name and Number ................................................................
Date Checked
----------/-----------/2011
Signature
............................................................................
EDITOR/ CODER
Name and Number ................................................................
Date Checked
----------/-----------/2011
Signature
............................................................................
SUPERVISOR
Name and Number ................................................................
Date Checked
----------/-----------/2011
Signature
............................................................................