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K1. Address ________
K2. LQ Number _ _ _
K3. What is the total number of persons who usually in this living quarters? _ _ _
(For Household 02 and thereafter, cancel K3 and K4.)
K4. How many households live in this living quarters? _ _
(For Household 02 and thereafter, cancel K3 and K4.)
Household is a group of persons who:
--Usually live together and
--Make common provisions for food and other essentials of living
K5. Household Number _ _
(For the second HH and thereafter, cancel part A and begin with part B)
Identification Particulars
Login
11
12
13
14
[Questions A2-9 were asked of living quarters which were built or converted for living.]
1
2
3
4
Brick
Plank
Brick and plank
Others (Specify) ____
2
3
4
5
6
A9. Does the garbage collection facility reach your living quarters/area?
[] 1 Yes, to this living quarters
[] 2 Yes, to this area
[] 3 None
B. Household Particulars
Mark X inside the relevant box for Question B2, and B6 - B10
-- Households
A household consists of related and/or unrelated persons who usually live together and make common
provisions for food and other essentials of living.
--Head of household
The head of household is any one of the household members who usually lives in the living quarters
and is regarded as head by the other household members.
[Questions B1 to B6 are recorded for all of the household members.]
B1. Given the names of persons who usually live together as members of this household on Census Day.
____
(Do not include persons who live in separate living quarters and who return to these living quarters
during weekends/ holidays only.)
Please refer to note provided below on this page.
Start with head of household followed by:
-- Spouse of head
-- Unmarried children
-- Married children and their families
-- Father/mother of head or spouse of head
-- Brother/sister of head or spouse of head
-- Other relatives
-- Others (e.g., servant, tenant, boarder)
B2. Besides the names of persons mentioned in question B1, did you miss out/are unsure of including any
other person who eats and lives together in this household?
-- Baby, young children
-----
Old People
Student(s) in primary/secondary school hostel
Servant
Tenant, boarder
1
2
3
4
5
6
Sight
Hearing
Speech
Limbs
Mental
Others
Motorcar
[] 1 unit
[] 2 unit
[] 3 units or more
Motorcycle /Scooter
[] 1 unit
[] 2 units or more
Bicycle
[] Bicycle
Others
[] Air-conditioner
[] Washing machine
[] Refrigerator
[] Microwave
[] Radio/Hi-fi
[] Television
[] Video/VCD/DVD
[] Fixed telephone line
[] Mobile phone
[] Personal computer (PC)
[] Internet subscription
C. Person Particulars
-- Mark X in one of the boxes for question C3, C4, C7, C9, C10(a), C12, C14, C18, C20, C24, C25(c),
C27, and C28.
-- Write the number or code in the boxes for question C1, C5, C6, C8, C10(b) and (c), C11, C13,
C29(a) and (b), and C30.
-- Write the number or words on the dotted lines.
Part C to be filled for each person with a given person number in B5.
____ member from a total of ____ household members
1
2
3
4
Never married
Married
Widowed
Divorced/permanently separated
C8. Which ethnic group or dialect group do you belong to? _ _ ____
(Refer to code card - Document 4)
1
2
3
4
5
6
7
Islam
Christianity
Hinduism
Buddhism
Confucianism/Taoism, other traditional Chinese religion
Tribal/fork religion
Others (Specify) ____
[] 8 No religion
C10. Birthplace
(a) Where were you born?
[] 1 Malaysia (Go to C10(b))
[] 2 Outside Malaysia (Go to C10(c))
(b) State of birth? _ _ (Specify state) ____
(Refer to code card - Document 4)
(Go to C12)
(c) Country of birth? _ _ (Specify country ) ____
(Refer to code card - Document 4)
[(Go to C11)]
C13. For non-Malaysian citizen, please specify country. _ _ (Write country) ____
(Refer to code card - Document 4)
C14. Where was your usual place of residence 5 years ago (i.e., in 1995)?
(For children aged less than 5 years (i.e., born after 1995) record mother's usual residence at time of
his/her birth)
[] 1 This house as in question K1
[] 2 Different house (Give full address)
[For those who answered "2" above]
(a) Name of street/housing estate ____
(b) Name of town/village ____
(c) Mukim/district(Kelantan)/sub-district(Sarawak) ____
(d) Administrative district/Jajahan(Kelantan) ____
(e) State/country ____
C21 Did you work for at least 1 hour during the last 7 days?
C23. Did you look for work during the last 7 days?
[Question C23 is asked of persons who were not working and who did not have any work to return to.]
[] 1 Yes (End interview for this person*)
[] 2 No
*In Sabah, W.P. Labuan and Sarawak, go to question C28 for ever married woman.
[Questions 25-27 were asked of persons who worked for at least one hour during the last 7 days or had a
job to return to.]
C25. Occupation
(a) What is your occupation? ____
(b) Please describe your duties/ nature of work. ____
(c) In which sector is your occupation?
[] 1 Government
[] 2 Private
[] 3 Own business
C26. Industry
(a) What are the activities/ services/ products of your place of work? (Describe in a few words) ________
(b) What is the name and address of your company/ employer? (If relevant only)
(i) Name of company/ employer: ________
(ii) Address of company/ employer: ________