APPENDIX 2
A National Census Form
FORM F 1
0 FFlcE USE
ONLY
HOUSEHOLO NUMBER
CONT
I I I 1
T O T A L PERSONS
I I
A
List all uma1members o f the household and visltoa Do not forger babres and old people
~~~~~~~~
RESIDENTS
O1
PERSON N U M B E R
1
~
List in rhis order /&?ad Wife of h e d , Never married children o f head (bv age). others
I
02
03
W H A T IS Y O U R N A X E ’
WHAT
IS Y O U R R E L A T I O N S H I P T O T H E H E A O O F
THIS HOUSEHOLD?
tvife. Son. DJrtgttrer Adopted Son. etc
W H E R E OIO Y O U S T A Y Y E S T E R D A Y ?
V I L LAGE I N TER VIELVS
I f staved in this wrllage or anorher vitIJge write ‘IN’,
I f stayed in town or non village write ‘OUT‘
NON V I L L A G E INTERVIEWS
I t sl;)yPd ir1 rtirs horise rtc w l t e IN
I f s f J y r d J i i y ~ l i e r e r l s e .f i r r r r O U T ’
I F ’OUT’ IN Q. 3. END O F QUESTIONS F O R THIS PERSON
4
SEX
LVrtrr M for irlale ‘ F ’ f o r female
W H A T IS Y O U R D A T E O F BIRTH’
/f d J t e
Of
hmh unhiiown
eSt!iliJIP
Jge in years
W H A T IS Y O U R CITIZENSHIP’
tvrire nane of c o u r i r ~ e g ONG. AUST, N I , UK
7
IN W H I C H P R O V I N C E A N O
O l S T R l C T (SUBP R O V I N C E )
W E R E Y O U BORN?
For exanliil’ E H P Lufa
N I P Karieng
I f horn oufwfr f a p l l a New
Guinea writecountry of hrrrh
UHAT
L
1
PRoVINCE
( s U e ~ ~ ~ I C T 1
IS T H E H I G H E S T G R A D E Y O U
F I N I S H E 0 A T SCHOOL?
tvrite r i r m t l e r of grarles or ’NIL ‘
0 0 Y O U C O T O C O M M U N I T Y OR H I G H S C H O O L
NOW?
10
tvrite YES‘or NO‘
L A S T W E E K , W H A T D I O Y O U DO M O S T
O F T H E T I M E ? Seecodesbelow
j I
No
1
CODES F O R QUESTION 10
01.
02.
03.
04.
05.
m.
07.
m.
09.
54
10.
Worked at a wage job.
On leave or temporarily absent from work.
Big or small-scalebusiness (including unpaid
helper).
Farming or fishing for food and money.
Farming or fishing, subsistence only.
Full-time student (incl. student on holiday).
Working in the house (e.g. housewife).
Too old or too young to work, or handicapped.
Other activities and looking for work.
Other activities and not looking for work.
I
I
No
1,,1
I
I
I
I
‘I
I
‘lES
OG
W E S A N Y O N E IN T H I S H O U S E H O L O .
(Nor lor
C r o w tea’
Grow spices?
J
wagelob)
I
I
II
l
I
........... .'G.D.?. .........
CENSUS UNIT N U M B E R ......... .o.o.-?...
..........
CENSUS UNIT NAME ......... .fij.L.ß. .........
u..
u-).
........G!j.! Y. .ß. ..............
........ hlb!.A.crJR.. ..........
PROVINCE
0 ISTR I CT
CENSUS DIVISION
o..
06
Day
IMonth
I
I
l
Year
Day
[Month
!
bonth
1
Year
Day
fMtrnth I
i
I
Y ears
Years
-~
Year, Day
j
Y rars
~
-
Runniny a hoat:canor?
__------
--.--
-. -
-
--
- - --
PJnnth
!
1
,
¡
Yrart
Day
)
~Mlonth
Year
Day
l'hth
I
Y ear Day
Mmth
I
i
Yew
!
I
Ycm,
- _-
u0
YES
i
1\11
Year
4 5 Years I
Years ,
Yufs
i
I
I_-
Yrar Day
+
CHE CK EO
@
55