Intensive Household Survey 2014 Intensive Household Survey 2014

Check Slip
1
2
3
4
7
8
9
House water tap
connection (A10 & 11)
Property tax assessment
( A12& 13)
Gas/LPG connection
( B8,9 & 10)
Electricity connection
(C14,15 & 16)
Caste Certificate (B5)
Birth Certificate (C5)
Disability (E)
10 Vehicle (G)
11 Land details (H)
Sl.No. Item Details Document
If Yes CAN No.
If Yes PTIN No.
Copy of Water Bill
If Yes Connection No.
Copy of PTIN Demand
Copy of Certificate
Copy of Pattedar Pass Book
Copy of Certificate
Copy of LPG Gas Bill
Copy of Certificate
Any Disabled Person
6
Adhar Card (B21)
(of all Family Members)
Name Card No. EID
Copy
(Y/N)
Item Yes / No No. of Vehicles Registration No.
Pattedar Pass Book No.:
Revenue Village :
District :
Yes* No*
Yes* No* Yes* No*
Yes* No*
Yes*
Yes* No*
5
Bank Account
(D12 & 13)
Copy :
Copy of Electricity Bill Connection
If Yes Meter
No*
No*
Yes*
Yes*
If Yes Meter No.
Bank Account
If Yes Bank Name
No* Yes*
Branch
Copy
(Y/N)
Account No.
SC* ST* OC* OBC*
SADAREM/Certificate No.
Motor Cycle/Scooter
3 Wheeler/ Auto
Car/Jeep
Air Conditioner
To be filled by you
*
Yes* No*
Yes* No*
Yes* No*
Yes* No*
Yes* No*
Yes* No* Yes* No*
Yes* No*
Yes* No*
Yes* No*
No*
5. Pincode No.
To be filled by Enumerator
Sex
M/F