CENSUS I
Strictly Confidential
Schedwle No................
-----_
Enumeration Area
s-I
5
P
Street and House Number
Census House Number ............
Household Number ...............
1 I
1
For persons aged 15 years and over only
C
O
.-c,
I
1
For all females aged 15 years
and over
Of the children f
Date of
you have born alive I last birth
7
W
o
U
V
C
u
X
m
o
al
f
2
\
2
3
5
6
1
'
J
7
9
II
13
15
I8
19
20
I
21
22
i
23
7
':J
4-69 TR
Please turn over
i
I
Household Particulars (To be asked of all Heads of Households)
Full Name of Head of Household ...........................................................................
Do you pay rent fcr these
prem ises?
Yes E2 No L N
ff ‘Yes’, is it to- ,
Private landlord ... ,:,a
Company
CIC
Government
... CEG
Local Authority ... C I L
Is electricity laid on these
pre m ises ?
What fuel is used for cooki ng?
... Ï E
Electricity
Gas
...
... L_iG
Wood charcoal and
coat
... ... r w
...
r-8
Other
i
s . .
i_
Where do you get your
water?
Private tap(s) (piped) O P
Shared tap(s) (piped) r7S
Weil or borehole
E W
River or stream
L_iR
Other
...
... ‘O
u
What type of toilet
med?
Flilsh
...
... F:
Aqua privy
... D
Piz
...
... i i
B8,tcket ...
... D
Nme
... ... D
is
A
P
B
N
Particulars of the House
(Where there are more than one household
in the house, to be asked of the Head of the
first Household only)
PH I Number of living rooms and bedrooms:
PH2 Material of construction:
Ï
I
Wal Is: ..........................................
Rcof: ............................................
D Number of deaths among members of the household in
the last 12 months (to be asked of all Heads of Households)
Children aged under 5 years
----
Males
Females
-
Persons aged 5 years and over
Males=SM
Females=5F
Enumerator’s Signature.. ...........................................
Supervisor’s Signature.. ...........................................
Date.. ..................................
Date.. ..................................