COOK ISLANDS
CENSUS OF POPULATION AND DWELLINGS
CPD-3/86
Confidential
All information .obtained in
this census will be kept
confidential and used for
statistical purposes only.
As at midnight between S u n d a y 30 Novernber a n d Monday 1 December 1986.
Personal Questionnaire
Statistics Off ice
(This census is taken under the authority of
the Statistics Act of 1966)
Rarotonga, Cook Islands
1 Person No.
Part A. TO be answered by or for each person alive and in the Cook Islands at midriight, between che 30 November am3 1 December 1986.
7.
Name:
1.
Surname
/
First Name
~
Sex: T i c k
2.
ln
-
(4) B o x - w h i c h
Male
2
Village
O1
0Head
03
n
05
Son/daughter
(b) i) If you usually live at the above
iddress T i c k (4) B o x a if not state your usual
residential-address:
Village/
1sland/
City
Country
1
ii) How long you have lived on the Island
of your usual residential address?
iT] Spouse
04
(b) Age as of last birthday
(d) If your residential address five ( 5 )
years ago was the same as in (b) i) above T i c k
If not, stace in full your usual
(4
BOX=
residential address as of 1 December 1981 (last
Census).
Village/
Island/
City
year (sl
~~~~
5.
Dependent of Temporary Contract Worker
3
Resident other than Cook Islands Maori
I
I
-
Day / Month / Year
~
2
(c) State number of years you have lived in
the Cook Islands.
year ( s )
n
(a) Date of birth:
4.
Temporary Contract Worker
(c) If your usual residential address one
year ago was the same as (b) i) above T i c k (dl
BOX
If not, state in full your usual
resiztial address of 1 December 1985.
Village/
Island/
10. Ethnic Origin: T i c k (
J
)
Box w h i c h a p p l i e s .
City
Country
I
I------
I
Specify
1
(b) Nationality:
year ( s )
Not related
Other
Guest
Island
(a) T i c k (d) Box which a p p l i e s .
applies.
0Female
02
Residential Status:: To be,answered by all
persons who are not Cook Islands Maori.
9.
~~
Relationship to Head of Household:
T i c k (if) Box which a p p l i e s ,
3.
(a) State full address on Census Night
Birthplace:
1
0
Cook Islands Maori
2
Cook Islands Maori/other
3
Other Ethnic Origin
Village/City
8.
Island/Country
6.
V k i t o r s O n l y : A visitor to the Cook Islands
is a person who will not have worked between
his or her date of arrival and date of departure. Visitors should T i c k (v)B o x a a n d go t o
d e c l a r a t i o n at the end of this questionnaire.
During the last five (5) years, have you
lived in other island(s) country (ies) f o r
a continuous period of s i x months or more?
If ves f i l l i n d e t a i l s asked for, below.
Ixands/
Main Reason
Country
for Move
Religion: T i c k
11.
Cook Islands Christian Church
2
Roman Catholic
4
I
which a p p l i e s .
1
3
I
(4Box
u
0
a
Church of Jesus Christ of Latter Day
Saints
Seventh Day Adventist
Other, specify
I
There is a right to object providing you
state 'object'.
h s t B, This part is t o be answered
persons 15 years of age and o v e r .
by
- -
12.
Marital ,tatus:
1-1
1
2
3
Tick
Never Married
I--[
(4) Box
4
Married
n
5
Widowed
which applies
Married but
pemanently separated
a
.
n
Divorced
(b) Name of employer: company, government, store or
person worked for
Education: (a) Tick (4) Box which applies.
(c) Type of business or activity employed in, e.g.
agriculture, fishing, retail store
or university
(Grade/Form/Stage)
land on the Island of usual residence and
other island(s) and none of the following
and go co 20 if
applies: Tick (J) Box
female, else go t o declaration.
(a) Principal Occupation: Give full details of
work done: e.g. cLtrus grower, wharf labourer,
accounts clerk
~
13.
Land Rights: Tick (J) Box which applies.
(a) A Cook Islander who wiil succeed to family
19.
6. Principal.Occupation:
.
gained:
Hours
worked:
14.
Social Welfare Benefits receivedin the last twelve
months: Tick (/) Box whlch applies.
Domestic purpose
1
None
Allowance
2
3
4
Child Benefit
L I
1-1
Old Age Pension
Ol
02
u
u
04
u
O'
7
1-
(a)
Were you engaged in other activities for gain? e.g.
agriculture for hone use, e x p o r t or local sales?
Tick (4 Box which applies.
1-1
Sick/Infim
Yes, continue
I I
n
You have a sub-lease,(go to 19 (c) 1
NO, go to 19
a
a
I
1
a
2
Working for wages part-time or casual basis
18)
4
(e) Number hours worked last week, or if you did not work
last week, give number of hours
usually worked:
Working mainly to produce for own use or
household consumption
Disabled,(go to 19)
11
Home duties
(a) Did
1
also look after children?
0 Yes
2
No
YOU
(c) Purpose of lease
House site
1
Agricultural
2
0
Other, describe
0
tiouse site
Agricultural
House site/
Agricultural
4
a
.
18. Unemployed only: Tlck
(4
BOX
20. Femaies Only: (Include all children born alive to you.
whlch applies.
I
Have you ever had paid work?
1
2
1-1
'
Total Number of children:
(a) Born alive:
(b) Still living
Yes, How many weeks since you last had
Males,,,,,,,,
Males--,-,,,,,-
paid work?
Females,,-,,,
Females
weeks.
I 1 No, (Has never had a paid work)
________
Date of birth of :
(c) First Child
(d) Last Child
(b) Did you also make crafts?
12
a
Other person not working for pay describe
(go to 19)
Other, describe
(d) State the size of the land for which the right
was granted by the High Court.
Hours
t o 19)
Full tine student and not working for wage o r
salary,(go to 17)
(b) Purpose of the
Occupation Right
House site/
Agricultural
Family worker in plantation or store or other
but not receiving wages
10
u
(d) Type of business or activity employed in: e.g.
agriculture, fishing, retail store
account business and no employees
Retired,(go
You have any other right to land,
please describe. __,,,,__,___
citrus grower,
(c) Name of employer: company, goverment, store or person
worked for
Tick (4 Box wnicn applies.
I
7
(b) Give full details of work done e.g.
wharf labourer, accounts clerk
:::efi:nsion
You have a sole occupation right,
(go to 19 (b) 1
You have a lease, (go to 19 (cl I
~
O8
O9
6
Unemployed and looking for work,(go t o
05
O6
5c3
11
Secondary Occupation:
Working full tine for wages o r salary
03
You are a land owner by succession and your
righc to the land has been determined by the
High Court. State Island(s)
You have a joint occupation right,
4
u (go t o 19 (b) )
7.
Employer, o m business or plantation
Own
2
3 0
~
Superannuation
'15. Activity Status:
You do not own land on the Island of usual
residence and do not have an occupational
right, or lease.
(d) Number of'hours worked last week, or if you did not work
la2t week, give number of hours usually
(d) Trade/Vocational or Professional
qualification gained:
1-1
1-1
1
21. Declaration: I HEREBY DECLARE THAT THE ABOVE PARTICULARS ARE TRUE AND COMPLETE TO THE BEST OF
Signature: