Survey Form

Form No.
Urban Semi urban Rural
Village
District
State
Date
Name

Gender Male Female

Marital status Married Unmarried Widow
Date of birth
You are Indian Non Indian
You are Resident of India Non resident of India
Contact no /
E-mail
Qualification Post Graduate & above Graduate 12th pass 10th pass
Uneducated Others______ __________________________
Details (if PG & above) _____________________________________
Occupation Pensioner Employee Business Owner Self Employed
Student House Wife Others _______________________
Org type MNC Public Ltd. Private Ltd.
Designation _____________________________________
Name of the Org/Business

Total year in job/business

Annual income Rs.
No of dependant

By Tanmay Mandal, Sec D, Roll 237 Page | 93