1.

Name: _______________________________________

2. Gender:

o Male
o Female

3. Age Group:

o 15 to 20 years
o 20 to 25 years
o 25 to 30 years
o 30 to 35 years
o 35 to 40 years

4. How long have you been using mobile phone?

o Less than 1 year

o 1 to 2 years
o 2 to 3 years
o 3 to 4 years
o 4 to 5 years
o More than 5 years

5. What are your reasons for using mobile phone? (Can

select multiple options)

 WAP
 Just talk on it
 Use GPRS function
 Receive and send E-mails and Messages
 Download screensaver and songs
 Other (Please specify): _______________________

6. Do you think use (under long period) of mobile would

cause health problem
E.g. Cancer

o Yes
o No
o No comment

7. What brand of mobile are you using now? (Can select

multiple options)

 Nokia
 Motorola
 Sony Errisson
 Samsung
 LG
 Tata
 Other (Please specify): ______________________

8. Why did you choose this model? (Can select multiple

options)

 Price
 Function
 Size and Weight
 Appearance
 Trend
 Advertisements
 Other (Please specify): ______________________
9. How many mobile phone(s) do your family have?

o 1
o 2
o 3
o 4
o More than 4

10. Are you satisfied with overall performance your mobile

phone provides? (Also enter single reason with it)

o Yes _______________
o No _______________

11. What phone accessories do you have? (Can select multiple

options)

 Cases
 Headsets
 Charges
 Bluetooth Headsets
 Speakers
 Memory Card
 Other (Please specify): ______________________