2012 FIES Questionnaire

Confidentiality: FIES FORM 1 (2012)
Section 4 of the Commonwealth Act No. 591 provides that all NSCB Approval No. NSO-1213-01
information furnished in this questionnaire shall be kept
` STRICTLY CONFIDENTIAL.
Expires: December 31, 2013
REPUBLIC OF THE PHILIPPINES

NATIONAL STATISTICS OFFICE
MANILA
2012 FAMILY INCOME AND EXPENDITURE SURVEY

(FIRST VISIT – JULY 2012)
PART I - A. IDENTIFICATION AND OTHER INFORMATION

Name of Respondent:
Geographic Identification Codes Line No.
PROVINCE Name of Household Head:
MUN/CITY Address:
BGY Interview Status

(Encircle appropriate code and enter in the box provided)
01 Completed Interview
EA ……………..…………………………
02 Refusal
03 No household member at home or
SHSN …………………………………..
No competent respondent at home at time of visit
04 Entire household absent for extended period of time
HCN …………………………………… 05 Vacant housing unit
06 Housing Unit destroyed/demolished.
Number of Households in the Housing Unit ……...... 07 Address not a housing unit
08 Housing unit not found
Total Number of Family Members Enumerated ……. 09 Critical or flooded area
10 Others, Specify ___________________
Certification
I hereby certify that the data gathered in this questionnaire were obtained/reviewed by me personally and in accordance
with instructions stated in the Interviewer’s Manual.
_______________________________ ______________ _______________________________ ____________

Signature Over Printed Name of Interviewer Date Accomplished Signature Over Printed Name of Supervisor Date Reviewed
Interviewer’s Code ………………. Supervisor’s Code ……………….

PAGE 3
B. PARTICULARS ABOUT THE FAMILY
[ FIRST VISIT - JULY 2012 ]

COPY FROM ISH FORM 2 ITEMS 1(a) TO 1(d).
ASK THE RESPONDENTS ITEMS 1(e) TO 1(h) AND ITEMS 2 to 7.
1. Particulars about the Head of the Family:
a. Sex:
b. Age
c. Marital Status
d. Highest Grade Completed
e. Did the head of the family have a job/business during the past six months?
1 YES 2 NO, GO TO ITEM 2

f. What was the primary occupation of the head of the family during the
past six months? _______________________________________
g. In what kind of industry did the head of the family work during the
past six months? _______________________________________
h. What was the class of worker of the head of the family during the
past six months? _______________________________________
2. What is the type of this household?

.
1 Single family
2 Extended family
3 Consisting of two or more non-related families or persons
3. How many members are there in the family?

(EXCLUDE MEMBERS WHO ARE OVERSEAS FILIPINOS, THAT IS, WITH
CODES “1” TO “4” IN COLUMN 12 OF ISH FORM 2)
4. How many family members are below 5 years old?
5. How many family members are 5 to 17 years old?
6a. How many family members including the head and his spouse were employed
for pay during the past six months?
6b. How many family members including the head and his spouse were employed
for profit during the past six months?
7. Did the spouse of the family head have a job/business during the past six months?
1 - YES 2 - NO 3 - NOT APPLICABLE
INSTRUCTIONS TO INTERVIEWERS:
UNLESS INSTRUCTED OTHERWISE, ALL ITEMS SHOULD BE ANSWERED BY ANY MEMBER OF THE FAMILY WHO IS
RESPONSIBLE IN THE MANAGEMENT OF THE FAMILY FINANCES.
ENCIRCLE APPROPRIATE CODES. ENTER CODES IN BOXES PROVIDED.

PAGE 4
PART II
EXPENDITURES AND OTHER DISBURSEMENTS
A. FOOD AND NON-ALCOHOLIC BEVERAGES
01.1 FOOD
01.1.1 BREAD AND CEREALS
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume bread and cereals?
1 - YES 2 - NO, GO TO PAGE 7 (01.1.2)

(b) How much is your consumption of the following?
Please give me the consumption on a weekly or monthly basis, or for the entire six months (January to June 2012).
RECEIVED AS GIFTS
IN CASH/ON CREDIT IN KIND
(Past six months)
Unit Quantity Value Reference Quantity Value Reference Quantity Value

Item Code Price Consumed Consumed Period Consumed Consumed Period Consumed Consumed
(ENTER (ENTER
CODE IN CODE IN
THE BOX. THE BOX.
(PESO) (PESO) IF CODE “9”, (PESO) IF CODE “9”, (PESO)
SPECIFY) SPECIFY)
1. Rice (in all forms)

a. Well milled, premium, fragrant, 011111 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
polished, or glazed
(jasmine, wagwag, dinorado,
sinandomeng, milagrosa, etc.)
b. Regular milled, commercial 011113 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
c. NFA rice 011114 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
d. Other variety of rice, n.e.c. 011119 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
_______________________ ______ ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
2. Corn
a. Corn on the cob 011121 ______ _________pcs ________ _____ _________pcs _________ _____ _________pcs _________
b. Whole corn, grain 011123 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
c. Corn grits 011126 ______ _________kg ________ _____ _________kg _________ _____ _________kg __________
d. Other corn (corn starch, etc.) 011129 ______ _______ ________ _____ _________ _________ _____ _________ __________
_______________________ ______ ______ _______ ________ _____ _________ _________ _____ _________ __________
CODES FOR THE REFERENCE PERIOD

1 - WEEKLY 2 – MONTHLY 3 – SIX MONTHS 9 – OTHERS, SPECIFY
PAGE 5

Please give me the consumption on a weekly or monthly basis, or for the entire six months (January to June 2012)
RECEIVED AS GIFTS
(6 months)

Price Consumed Consumed Period Consumed Consumed Period Consumed Consumed
Item Code
(ENTER
(ENTER CODE IN
CODE IN THE BOX.
THE BOX. IF CODE “9”,
(PESO) (PESO) IF CODE “9”, (PESO)
SPECIFY)
SPECIFY)
3. Flour
a. Wheat flour (all purpose) 011131 ______ _______ kg ________ _____ _______ kg _________ _____ _________kg __________
b. Corn (maize) flour 011136 ______ _______ kg ________ _____ _______ kg _________ _____ _________kg __________
c. Other, n.e.c. 011139 ______ _______ kg ________ _____ _______ kg _________ _____ _________kg __________
_______________________ ______ ______ _______ kg ________ _____ _______ kg _________ _____ _________kg __________
4. Other Cereal Preparation
a. Flakes (cornflakes, puffed rice, 011141 ______ _______ g ________ _____ _______ g _________ _____ _________g __________
oatflakes and similar products)
b. Native cakes (puto, bibingka, 011142 ______ _______ g ________ _____ _______ g _________ _____ _________g __________
biko, suman, etc., prepared
from rice)
c. Infant food cereal-based 011143 ______ _______ g ________ _____ _______ g _________ _____ _________g __________
d. Ready mixed noodle soup 011144 ______ _______ g ________ _____ _______ g _________ _____ _________g __________
e. Junk food cereal-based 011145 ______ _______ g ________ _____ _______ g _________ _____ _________g __________
f. Other cereal preparations and 011149 ______ _______ ________ _____ _______ _________ _____ _________ __________
other products, n.e.c.
(champorado, arrozcaldo, etc.)
_______________________ ______ ______ _______ ________ _____ _______ _________ _____ _________ __________

PAGE 6

(b ) How much is your consumption of the following?
Please give me the consumption on a weekly or monthly basis, or for the entire six months (January to June 2012)
RECEIVED AS GIFTS
(6 months)

Item Code Price Consumed Consumed Period Consumed Consumed Period Consumed Consumed
(ENTER (ENTER
CODE IN CODE IN
THE BOX. THE BOX.
(PESO) (PESO) IF CODE “9”, (PESO) (PESO) IF CODE “9”, (PESO)
SPECIFY) SPECIFY)
5. Bread and Other Bakery Products

a. Loaf bread 011161 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
b. Pandesal 011162 ______ _______ pcs ________ _____ _______pcs _________ _____ _______pcs ___________
c. Biscuits 011163 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
d. Crackers 011165 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
e. Cookies, cakes, hopia, pies 011166 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
f. Other bread and bakery 011169 ______ _______ ________ _____ _______ _________ _____ _________ ___________
products, n.e.c. (lumpia
wrapper, croissants, etc.)
_______________________ ______ ______ _______ ________ _____ _______ _________ _____ _________ ___________
6. Pasta Products in All Forms
a. Pasta 011171 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
(macaroni, spaghetti, etc.)
b. Noodles 011172 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
(sotanghon, bihon, etc.)
c. Instant noodles 011173 ______ _______ g ________ _____ _______ g _________ _____ _________g ___________
d. Other pasta products, n.e.c. 011179 ______ _______ ________ _____ _______ _________ _____ _________ ___________
_______________________ ______ ______ _______ ________ _____ _______ _________ _____ _________ ___________
7. Other Bread and Cereals, N.E.C.. 011190 ______ _______ ________ _____ _______ _________ _____ _________ ___________

PAGE 7
01.1.2 MEAT
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume fresh meat and meat preparations?
1 - YES 2 - NO, GO TO PAGE 9 (01.1.3)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code Unit Quantity Value Quantity Value Quantity Value
Price Consumed Consumed (ENTER Consumed Consumed ENTER Consumed Consumed
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Meat, Fresh, Chilled or Frozen
a. Beef 011211 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg _______
b. Pork 011212 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg _______
c. Goat 011214 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg _______
d. Chicken 011216 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg _______
e. Other meat 011219 _____ _______ ________ _____ _______ ________ _____ _______ _______
(frog’s meat, sheep, etc.)
_______________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ _______
2. Fresh, Chilled or Frozen Edible Offal, 011220 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg _______
(liver, gizzard, etc.)
3. Dried, Salted or Smoked Meat and 011230 _____ _______ g ________ _____ _______ g ________ _____ _______ g _______
Edible Offal (canned or uncanned)

PAGE 8
01.1.2 MEAT
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Price Consumed Consumed (ENTER Consumed Consumed (ENTER Consumed Consumed
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
4. Preserved or Processed Meat and

Meat-based preparation
a. Tocino, tapa 011241 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
b. Hotdog, longaniza, chorizo 011242 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
c. Corned beef 011243 _____ _______ g ________ _____ _______ g ________ _____ _______ g ________
d. Luncheon meat, meatloaf, 011244 _____ _______ g ________ _____ _______ g ________ _____ _______ g ________
embotido
e. Sausages, bacon 011245 _____ _______ g ________ _____ _______ g ________ _____ _______ g ________
f. Salami, ham 011246 _____ _______ g ________ _____ _______ g ________ _____ _______ g ________
g. Other prepared or processed 011249 _____ _______ ________ _____ _______ ________ _____ _______ ________
meat (liver spread, potted meat)
_______________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________

PAGE 9
01.1.3 FISH AND SEAFOOD

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume fish and seafood?
1 - YES 2 - NO, GO TO PAGE 12 (01.1.4)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
(ENTER (ENTER
Price Consumed Consumed CODE IN
Consumed Consumed Consumed Consumed
CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Fish, Fresh, Chilled or Frozen

a. Galunggong (Round scad) 011311 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
b. Bangus (Milkfish) 011312 _____ _______kg ________ _____ _______kg ________ _____ _______kg
c. Tilapia 011313 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
d. Lapu-lapu 011314 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
e. Dilis (Anchovies) 011315 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
f. Mackerel (hasa-hasa 011316 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
alumahan, and tanigue)
g. Salmon 011317 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
h. Tuna 011318 _____ _______kg ________ _____ _______kg ________ _____ _______kg ________
i. Other fish, fresh or chilled, 011319 _____ _______ ________ _____ _______ ________ _____ _______ ________
n.e.c. (dalagang bukid, etc.)
_______________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________

PAGE 10

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
2. Dried, Smoked or Salted Fish

a. Bisugo 011321 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
b. Tuyo 011322 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
c. Tamban 011324 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
d. Dilis 011328 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
e. Other dried, smoked or salted 011329 _____ _______ ________ _____ _______ ________ _____ _______ ________
fish, n.e.c.
(bangus, galunggong, etc.)
_________________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________
3. Fresh, Chilled or Frozen Seafoods
a. Shrimps/Prawns/Lobster 011331 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
b. Crabs 011332 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
c. Squids 011333 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
d. Shells and mollusks 011334 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
e. Other seafood, fresh, chilled 011339 _____ _______ ________ _____ _______ ________ _____ _______ ________
or frozen, n.e.c. (land and sea
snails, seaweeds, etc.)
_________________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________

PAGE 11

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
4. Fish otherwise Prepared or

Preserved, Canned or Bottled, n.e.c.
a. Fish in oil or in sauce, canned 011341 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
or bottled (mackerel, sardines)
b. Fish marinated (bagoong, 011342 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
burong isda, etc.)
c. Other fish prepared or preserved 011349 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
canned or bottled, n.e.c.
________________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________
5. Seafood-based Preparations
Canned or Bottled, n.e.c.
a. Squid, canned or bottled 011351 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
b. Other seafood-based 011359 _____ _______ kg ________ _____ _______ kg ________ _____ _______ kg ________
preparations, canned or
bottled, n.e.c. (burong talangka,
alamang, salted shells, etc.)
________________________ ______ _____ _______ ________ _____ _______ ________ _____ _______ ________

PAGE 12
01.1.4 MILK, CHEESE AND EGGS

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume milk, cheese and eggs?
1 - YES 2 - NO, GO TO PAGE 14 (01.1.5)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Raw milk
a. Milk raw, not pasteurized 011411 ______ ______ml ________ _____ _______ ml ________ _____ _______ml ________
b. Milk, pasteurized or sterilized, 011412 ______ ______ml ________ _____ _______ml _________
ready to drink
2. Condensed, evaporated or
powdered milk
a. Condensed milk 011421 ______ ______ml ________ _____ _______ml ________

b. Evaporated milk 011422 ______ ______ml ________ _____ _______ml ________
c. Powdered Infant milk 011423 ______ ______g ________ _____ _______g ________
d. Advanced formula adult , 011424 ______ ______g ________ _____ _______g ________
powdered milk
e. Other powdered milk 011425 ______ ______ ________ _____ _______g ________
__________________________ ______ ________ _____ _______ ________
3. Yoghurt, cream, milk based dessert 011430 ______ ______ ________ _____ _______ ________
4. Milk based beverages and 011440 ______ ______ ________ _____ _______ ________ _____ _______ ________
other milk-based products
5. Soya milk 011450 ______ ______ml ________ _____ _______ml ________

PAGE 13
01.1.4 MILK, CHEESE AND EGGS

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
6. Cheese and Curd

a. Fresh cheese (kesong puti, 011461 ______ ______g ________ _____ _______ g ________ _____ _______g ________
cottage cheese)
b. Grated or processed cheese 011463 ______ ______g ________ _____ _______g ________
c. Processed cheese (not grated or 011464 ______ ______g ________ _____ _______g ________
powdered)
d. Other cheese and curd, n.e.c. 011469 ______ ______g ________ _____ _______ g ________ _____ _______g ________
__________________________ ______ ______ ______g ________ _____ _______ g ________ _____ _______g ________
7. Eggs
a. Fresh (chicken) 011471 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs ________
b. Fresh (quail) 011472 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs _________
c. Fresh (ducks) 011473 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcsl ________
d. Processed (salted eggs) 011475 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs ________
e. Processed (balut) 011476 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs ________
f. Others (turtle’s egg, etc.) 011478 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs ________
g. Other egg products made 011479 ______ ______pcs ________ _____ _______pcs ________ _____ ______pcs ________
wholly from eggs
__________________________ ______ ______ ______ ________ _____ _______ ________ _____ _______ ________
8. Other milk, cheese and eggs, n.e.c. 011490 ______ ______ ________ _____ _______ ________ _____ _______ ________

PAGE 14
01.1.5 OILS AND FATS

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume oils and fats?
1 - YES 2 - NO, GO TO NEXT PAGE (01.1.6)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Butter and butter products 011510 ______ ______g ________ _____ _______g ________
2. Margarine
a. Margarine 011521 ______ ______g ________ _____ _______g ________

b. Peanut butter 011522 ______ ______g ________ _____ _______g ________
c. Butter and other fats and oil 011529 ______ ______g ________ _____ _______g ________
derived from milk
3. Edible oils
a. Corn oil 011532 ______ ______ml ________ _____ _______ml ________
b. Coconut oil including milk 011533 ______ ______ml ________ _____ _______ml ________ _____ _______ml ________
c. Other edible oils, n.e.c. 011539 ______ ______ml ________ _____ _______ml ________ _____ _______ml ________
(canola oil, palm oil, soya bean
oil, peanut oil, etc.)
________________________ ______ ______ ______ ________ _____ _______ ________ _____ _______ ________
4. Edible animal fats (lard, etc.) 011540 ______ ______g ________ _____ _______g ________ _____ _______g ________

PAGE 15
01.1.6 FRUIT
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume fruits?
1 - YES 2 - NO, GO TO PAGE 17 (01.1.7)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Fresh Fruits
a. Pineapple 011611 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
b. Mango 011612 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
c. Banana 011613 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
d. Papaya 011614 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
e. Dalanghita 011615 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
f. Other fresh fruits, n.e.c. 011619 ______ ______kg ________ _____ _______ kg ________ _____ _______kg _______
________________________ ______ ______ ______ ________ _____ _______ ________ _____ _______ _______
2. Dried/Preserved Fruits
a. Pineapple 011621 ______ ______kg ________ _____ _______ g ________ _____ _______ g _______
b. Mango 011622 ______ ______kg ________ _____ _______ g ________ _____ _______ g _______
c. Other fruit dried, n.e.c. 011629 ______ ______kg ________ _____ _______ g ________ _____ _______ g _______
________________________ ______ ______ ______kg ________ _____ _______ ________ _____ _______ _______

PAGE 16
01.1.6 FRUIT
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY SPECIFY
3. Fruit, Nuts and Edible Seeds

a. Peanut 011631 ______ ______kg ________ _____ _______kg ________ _____ _______kg _______
b. Cashew nut 011632 ______ ______kg ________ _____ _______kg ________ _____ _______kg _______
c. Coconut 011633 ______ ______pcs ________ _____ _______pcs ________ _____ _______pcs _______
d. Other fruit nuts and 011639 ______ ______ ________ _____ _______ ________ _____ _______ _______
edible seeds, n.e.c.
________________________ ______ ______ ______ ________ _____ _______ ________ _____ _______ _______
4. Preserved Fruit and Fruit-based

Products
a. Pineapple 011641 ______ ______g ________ _____ _______g ________ _____ _______g _______
b. Mango 011642 ______ ______g ________ _____ _______g ________ _____ _______g _______
c. Mixture of Fruits (fruit cocktail) 011646 ______ ______g ________ _____ _______g ________ _____ _______g _______
d. Other fruit preserved and 011649 ______ ______ ________ _____ _______ ________ _____ _______ _______
fruit based products
________________________ ______ ______ ______ ________ _____ _______ ________ _____ _______ _______
5. Kaong preserves 011650 ______ ______g ________ _____ _______g ________ _____ _______g _______
6. Nata de coco 011660 ______ ______g ________ _____ _______g ________ _____ _______g _______

PAGE 17
01.1.7 VEGETABLES
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume vegetables?
1 - YES 2 - NO, GO TO PAGE 21 (01.1.8)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Vegetables Cultivated for their

Leaves or Stalks (Fresh, chilled,
frozen or dried)
a. Cabbage 011711 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
b. Ampalaya leaves 011712 ______ ____bundle ________ _____ _____bundle ________ _____ _____bundle _______
c. Camote tops 011713 ______ ____bundle ________ _____ _____bundle ________ _____ _____bundle _______
d. Kangkong 011714 ______ ____bundle ________ _____ _____bundle ________ _____ _____bundle _______
e. Malunggay leaves 011715 ______ ____bundle ________ _____ _____bundle ________ _____ _____bundle _______
f. Pechay 011716 ______ ____bundle ________ _____ _____bundle ________ _____ _____bundle _______
g. Other vegetables cultivated for 011719 ______ _________ ________ _____ __________ ________ _____ __________ _______
their leaves or stalks, fresh or
dried, n.e.c.
________________________ ______ ______ _________ ________ _____ __________ ________ _____ __________ _______
Fruit ( Fresh, chilled, frozen or
dried)
a. Ampalaya 011721 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
b. Eggplant 011722 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
c. Squash 011723 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______

PAGE 18
01.1.7 VEGETABLES
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
d. Okra 011724 ______ ____bundle ________ _____ _____bundle ________ _____ ____bundle _______
e. Tomato 011726 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
f. Beans and legumes 011728 ______ _______ ________ _____ _______ ________ _____ _______ _______
(stringbeans, mongo, togue,
olives, etc.)
g. Other vegetables cultivated for 011729 ______ _______ ________ _____ _______ ________ _____ _______ _______
their fruit, fresh, chilled or
dried, n.e.c.
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______

Roots (Fresh, chilled, frozen or
dried)
a. Onions 011731 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
b. Carrots 011732 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
c. Raddish 011733 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
d. Garlic 011734 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
e. Tugui 011736 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
f. Other vegetables cultivated for 011739 ______ _______ ________ _____ _______ ________ _____ _______ _______
roots, fresh or dried, frozen or
dried, n.e.c.
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______

PAGE 19
01.1.7 VEGETABLES
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
4. Potatoes and Tuber Vegetables,

(Fresh or Dried)
a. Potatoes 011741 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
b. Camote 011742 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
c. Cassava 011743 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
d. Gabi 011744 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
e. Ube 011745 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
f. Other potatoes and tuber 011749 ______ _______ ________ _____ _______ ________ _____ _______ _______
vegetables, fresh or dried, nec.
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______
5. Vegetables Preserved or Processed
and Other Veg.-based Products
______ _______kg
a. Potatoes (French Fries) 011751 ________ _____ _______kg ________ _____ _______kg _______
b. Processed Camote 011752 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
c. Pickled vegetables 011757 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
d. Tokwa, tausi and miso 011758 ______ _______kg ________ _____ _______kg ________ _____ _______kg _______
e. Other vegetables, preserved or 011759 ______ _______ ________ _____ _______ ________ _____ _______ _______
processed and vegetables-
based products, nec.
(pork and beans, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______

PAGE 20
01.1.7 VEGETABLES
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code Value Value Value
Unit Quantity Quantity Quantity
Consumed (ENTER Consumed (ENTER Consumed
Price Consumed Consumed Consumed
CODE IN CODE IN
(PESO) THE BOX. (PESO) THE BOX. (PESO)
(PESO) IF CODE “9”, IF CODE “9”,
SPECIFY) SPECIFY)
6. Products of Tuber Vegetables

Including Preparations
a. Potato chips 011761 ______ _______g ________ _____ _______g ________ _____ _______g _______
b. Cassava cake 011762 ______ _______g ________ _____ _______g ________ _____ _______g _______
c. Haleya (ube) 011763 ______ _______g ________ _____ _______g ________ _____ _______g _______
d. Other products of tuber 011769 ______ _______ ________ _____ _______ ________ _____ _______ _______
vegetables including
preparations, nec.
(camote cue, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______

PAGE 21
01.1.8 SUGAR, JAM, HONEY, CHOCOLATE AND CONFECTIONERY

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume sugar, jam, honey, chocolate, confectionery products and
ice cream?
1 - YES 2 - NO, GO TO PAGE 23 (01.1.9)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Sugar
a. Centrifugal sugar 011811 ______ _______kg ________ _____ _______kg ________
b. Muscovado 011812 ______ _______kg ________ _____ _______kg ________

c. Refined brown sugar 011815 ______ _______kg ________ _____ _______kg ________
d. Other sugar (panocha, etc.) 011819 ______ _______kg ________ _____ _______kg ________ _____ _______kg ________
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
2. Jams, Marmalades, Jellies
a. Jams 011821 ______ _______g ________ _____ _______g ________ _____ _______g ________
b. Marmalades 011822 ______ _______g ________ _____ _______g ________ _____ _______g ________
c. Fruit jellies 011825 ______ _______g ________ _____ _______g ________ _____ _______g ________
d. Other jams, marmalades, 011829 ______ _______ ________ _____ _______ ________ _____ _______ ________
fruit jellies, n.e.c.
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
3. Honey 011830 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________

PAGE 22
01.1.8 SUGAR, JAM, HONEY, CHOCOLATE AND CONFECTIONERY

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
4. Chocolates 011840 ______ _______g ________ _____ _______g ________

5. Ice cream, Sorbet and Edible Ice
a. Ice cream 011851 ______ _______ml ________ _____ _______ml ________
b. Other ice cream, sorbet and 011859 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
edible ice, nec.
(ice candy, ice, ice buko, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
6. Other sugar, jam, honey, chocolate 011890 ______ _______ ________ _____ _______ ________ _____ _______ ________
and confectionery products, n.e.c.
(chewing gum, candies, pastilles,
meringue, bukayo, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________

PAGE 23
01.1.9 FOOD PRODUCTS NOT ELSEWHERE CLASSIFIED

(a) During the period JANUARY to JUNE, 2012, did you or any member of your family consume any food not elsewhere classified such as salt, spices,
culinary herbs, sauces, condiments and seasoning, vinegar and soups, broths, stocks and culinary ingredients?
1 - YES 2 - NO, GO TO PAGE 25 (01.2)
RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Salt
a. Rock salt 011911 ______ _______g ________ _____ _______g ________ _____ ________g _________
b. Iodized salt 011912 ______ _______g ________ _____ ________g _________
2. Spices and Culinary Herbs

a. Pepper, crushed or ground 011921 ______ _______g ________ _____ _______g ________ _____ ________g _________
b. Pimenta 011922 ______ _______g ________ _____ _______g ________ _____ ________g _________
c. Ginger 011923 ______ _______g ________ _____ _______g ________ _____ ________g _________
d. Vetsin 011924 ______ _______g ________ _____ ________g _________
e. Laurel 011927 ______ _______g ________ _____ _______g ________ _____ ________g _________
f. Other spices and culinary 011929 ______ _______ ________ _____ _______ ________ _____ ________ _________
herbs, n.e.c..
________________________ ______ ______ _______ ________ _____ _______ ________ _____ ________ _________

1 - WEEKLY 2 – MONTHLY 3 – SIX MONTHS 9 – OTHERS SPECIFY
PAGE 24
01.1.9 FOOD PRODUCTS NOT ELSEWHERE CLASSIFIED

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
3. Sauces, Condiments and

Seasonings
a. Soya sauce 011931 ______ _______ml ________ _____ _______ml ________ _____ ________ml _________
b. Tomato catsup and 011932 ______ _______ml ________ _____ ________ml _________
other tomato sauces
c. Banana catsup 011934 ______ _______ml ________ _____ ________ml _________
d. Salad dressing and 011935 ______ _______ml ________ _____ _______ml ________ _____ ________ml _________
mayonnaise
e. Patis 011936 ______ _______ml ________ _____ _______ml ________ _____ ________ml _________
f. Other sauces, condiments and 011939 ______ _______ ________ _____ _______ ________ _____ ________ _________
seasonings, n.e.c.
(ginisa mix, meat cubes,
lechon sauce, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ ________ _________
4. Vinegar 011940 ______ _______ml ________ _____ _______ml ________ _____ ________ml _________
5. Dessert preparation and soups, 011960 ______ _______ ________ _____ ________ _________
broth, stocks & culinary ingredients
6. Homogenized baby food and 011970 ______ _______ ________ _____ ________ _________
dietary preparations
7. Other food products, N.E.C. 011999 ______ _______ ________ _____ ________ _________

PAGE 25
01.2 NON-ALCOHOLIC BEVERAGES
01.2.1 COFFEE, TEA AND COCOA
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume any coffee, tea or cocoa?
1 - YES 2 - NO, GO TO NEXT PAGE (01.2.2)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Coffee, whether or not decaffeinated

a. Coffee, instant 012111 ______ _______g ________ _____ _______g _______
b. Coffee, roasted or ground 012112 ______ _______g ________ _____ _______g ________ _____ _______g _______
c. Other coffee based-beverages 012113 ______ _______g ________ _____ _______g _______
2. Tea
a. Green tea 012121 ______ _______g ________ _____ _______g _______
b. Black tea 012122 ______ _______g ________ _____ _______g _______
c. Other plant products for 012129 ______ _______ ________ _____ _______ ________ _____ _______ _______
infusions (pito-pito)
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ _______
3. Cocoa
a. Cocoa, powdered 012131 ______ _______g ________ _____ _______g _______
(Milo, Ovaltine, etc.)
b. Cocoa, processed 012132 ______ _______g ________ _____ _______g ________ _____ _______g _______
(ricoa, cocoa, tablea, etc.)
c. Cocoa beans (cacao) 012133 ______ _______ ________ _____ _______ ________ _____ _______ _______
4. Cocoa-based Beverage Preparations 012140 ______ _______ ________ _____ _______ _______

PAGE 26
01.2.2 MINERAL WATER, SOFT DRINKS, FRUIT AND VEGETABLES JUICES

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume any non-alcoholic beverages such as mineral water,
softdrinks, fruit and vegetable juices?
1 - YES 2 - NO, GO TO PAGE 28 (02.1)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Mineral or Spring Water, All Drinking 012210 ______ _______ml ________ _____
Water Sold in Containers _______ml ________
2. Soft drinks 012220 ______ _______ml ________ _____ _______ml ________
3. Fruits and Vegetables Juices,
Powder
a. Pineapple juice 012231 ______ _______g ________ _____ _______g ________
b. Mango juice 012232 ______ _______g ________ _____ _______g ________
c. Orange juice 012233 ______ _______g ________ _____ _______g ________
d. Guyabano juice 012234 ______ _______g ________ _____ _______g ________
e. Apple juice 012235 ______ _______g ________ _____ _______g ________
f. Tomato juice 012236 ______ _______g ________ _____ _______g ________
g. Calamansi juice 012237 ______ _______g ________ _____ _______g ________
h. Salabat powder 012238 ______ _______g ________ _____ _______g ________
i. Other fruit and vegetables 012239 ______ _______ ________ _____ _______ ________
juices, powder, nec.
(lime juice, ginger ale, etc.)
________________________ ______ ______ _______ ________ _____ _______ ________

PAGE 27
01.2.2 MINERAL WATER, SOFT DRINKS, FRUIT AND VEGETABLE JUICES

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
4. Concentrates and Ready to Drink

Juice
a. Pineapple juice 012241 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
b. Orange juice 012242 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
c. Mango juice 012243 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
d. Guyabano juice 012244 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
e. Tomato juice 012245 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
f. Grapefruit juice 012246 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
g. Calamansi juice 012247 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
h. Apple juice 012248 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
i. Other concentrates and ready 012249 ______ _______ ________ _____ _______ ________ _____ _______ ________
to drink juices, n.e.c.
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
5. Other Non-Alcoholic Beverages, 012900 ______ _______ ________ _____ _______ ________ _____ _______ ________
N.E.C. (energy drink such as
Lipovitan, Red Bull, Joss, Cobra
Gatorade, etc.)

PAGE 28
B. ALCOHOLIC BEVERAGES AND TOBACCO

02.1 ALCOHOLIC BEVERAGES
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume any alcoholic beverages such as liquor, wine and beer?
1 - YES 2 - NO, GO TO PAGE 29 (02.2)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
CODE IN CODE IN
THE BOX. THE BOX.
SPECIFY) SPECIFY)
1. Liquor
a. Whisky 021110 ______ _______ml ________ _____ _______ml ________
b. Rum 021120 ______ _______ml ________ _____ _______ml ________
c. Gin 021130 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
d. Brandy 021140 ______ _______ml ________ _____ _______ml ________
e. Voodka (lambanog, etc.) 021150 ______ _______ml ________ _____ _______ml ________
f. Other liquors, n.e.c. 021190 ______ _______ ________ _____ _______ ________ _____ _______ ________
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
2. Wine
a. Tuba (palm) wine 021210 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
b. Basi 021220 ______ _______ml ________ _____ _______ml ________ _____ _______ml ________
c. Other wines, n.e.c. 021290 ______ _______ ________ _____ _______ ________ _____ _______ ________
________________________ ______ ______ _______ ________ _____ _______ ________ _____ _______ ________
3. Beer 021300 ______ _______ml ________ _____ _______ml ________

PAGE 29
02.2 TOBACCO
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume cigarettes, cigars and other manufactures tobacco?
1 - YES 2 - NO, GO TO (02.3) BELOW

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code Quantity Value Quantity Value Quantity Value
Consumed Consumed (ENTER Consumed Consumed (ENTER Consumed Consumed
CODE IN CODE IN
THE BOX. THE BOX.
(PESO) IF CODE “9”, (PESO) IF CODE “9”, (PESO)
SPECIFY) SPECIFY)
1. Cigarettes containing tobacco 022010 _______sticks ________ _____ ______sticks ________
2. Cigars, 022020 _______sticks ________ _____ ______sticks ________
3. Chewing tobacco 022040 _______ ________ _____ _______ ________ _____ ______ ________
4. Other tobacco, n.e.c. 022090 _______ ________ _____ _______ ________ _____ ______ ________
________________________ ______ _______ ________ _____ _______ ________ _____ _______ ________
02.3 OTHER VEGETABLE-BASED PRODUCTS

(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume betel leaves, betel nuts, and other vegetable-based products?
1 - YES 2 - NO, GO TO NEXT PAGE (C)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code Quantity Value
Quantity Value (ENTER (ENTER
Quantity Value
Consumed Consumed
Consumed Consumed CODE IN CODE IN Consumed Consumed
THE BOX. THE BOX.
IF CODE “9”, IF CODE “9”,
SPECIFY) SPECIFY)
1. Betel leaves and betel nuts 023020 _________ ________ _____ _________ ________ _____ _________ ________
2. Others (mint leaf and lime) 023090 _________ ________ _____ _________ ________ _____ _________ ________
CODES FOR REFERENCE PERIOD

PAGE 30
C. CLOTHING AND FOOTWEAR

During the period JANUARY to JUNE 2012, did you or any member of your family purchase in cash or on credit, or
receive as gift any clothing materials, garments, other articles of clothing and clothing accessories, shoes, and other
footwear, and pay for service fees?
1 - YES 2 - NO, GO TO PAGE 33 (D)
Unit
In Cash/ Received
Item Code Quantity Price Total
On Credit as Gifts
(PESO)
CLOTHING 031000 XXXXXX XXXXX ======== ======= =======
1. Clothing Materials 031100 ________ ______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. Garments 031200 XXXXXX XXXX ======== ======= =======
a. Garments for Men (18 years old and above) 031210 XXXXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
a.1 Pants, short 031211 ______ pcs ______ _________ ________ ________
a.2 T-shirts, polo shirts 031212 ______ pcs ______ _________ ________ ________
a.3 Underwear (supporter, briefs, etc.) 031213 ______ pcs ______ _________ ________ ________
a.4 Socks 031214 ______ pcs ______ _________ ________ ________
a.5 Other garments for men, n.e.c. 031219 ______ pcs ______ _________ ________ ________
__________________________________ _______ ______ pcs ______ _________ ________ ________
b. Garments for Women (18 years old and above) 031220 XXXXXX XXXX ______ _____ _____
b.1 Dress, suits 031221 ______ pcs ______ _________ ________ ________
b.2 Pants 031222 ______ pcs ______ _________ ________ ________
b.3 Blouses, T-shirts, skirts 031223 ______ pcs ______ _________ ________ ________
b.4 Underwear (panties, bra, chemise, etc.) 031224 ______ pcs ______ _________ ________ ________
b.5 Stockings, panty hose, socks, tights 031225 ______ pcs ______ _________ ________ ________
b.6 Raincoats, jackets, sweater, capes 031226 ______ pcs ______ _________ ________ ________
b.7 Other garments for women, n.e.c. 031229 ______ pcs ______ _________ ________ ________
__________________________________ _______ ______ pcs ______ _________ ________ ________
c. Garments for Boys (below 10 years old) 031230 XXXXXX XXXX ______ _____ _____
c.1 Pants, shorts 031231 ______ pcs ______ _________ ________ ________
c.2 Shirts/T-shirts 031232 ______ pcs ______ _________ ________ ________
c.3 Underwear (brief, sando, etc.) 031233 ______ pcs ______ _________ ________ ________
c.4 Socks 031234 ______ pcs ______ _________ ________ ________
c.5 Raincoats, jackets, sweater, capes 031235 ______ pcs ______ _________ ________ ________
c.6 Other garments for boys, n.e.c 031239 ______ pcs ______ _________ ________ ________
_____________________________________ _______ ______ pcs ______ _________ ________ ________
d. Garments for Boys (10 to 17 years old) 031240 XXXXXX XXXX ______ _____ _____
d.1 Pants, shorts 031241 ______ pcs ______ _________ ________ ________
d.2 Shirts/T-shirt 031242 ______ pcs ______ _________ ________ ________
d.3 Underwear (brief, sando, etc.) 031243 ______ pcs ______ _________ ________ ________
d.4 Socks 031244 ______ pcs ______ _________ ________ ________
d.5 Raincoats, jackets, sweater, capes 031245 ______ pcs ______ _________ ________ ________
d.6 Other garments for boys, n.e.c 031249 ______ pcs ______ _________ ________ ________
PAGE 31

Unit
In Cash/ Received
On Credit as Gifts
(PESO)
e. Garments for Girls (below 10 years old) 031250 XXXXXX XXXX ______ _____ _____
e.1 Dress 031251 ______ pcs ______ _________ ________ ________
e.2 Pants, shorts 031252 ______ pcs ______ _________ ________ ________
e.3 Blouses, t-shirts, skirts 031253 ______ pcs ______ _________ ________ ________
e.4 Underwear (panties, etc.) 031254 ______ pcs ______ _________ ________ ________
e.5 Stockings, panty hose, socks, tights 031255 ______ pcs ______ _________ ________ ________
e.6 Raincoats, jackets, sweater, capes 031256 ______ pcs ______ _________ ________ ________
e.7 Other garments for girls, n.e.c. 031259 ______ pcs ______ _________ ________ ________
__________________________________ _______ ______ pcs ______ _________ ________ ________
f. Garments for Girls (10 to 17 years old) 031260 XXXXXX XXXX ______ _____ _____
f.1 Dress 031261 ______ pcs ______ _________ ________ ________
f.2 Pants, shorts 031262 ______ pcs ______ _________ ________ ________
f.3 Blouses, t-shirts, skirts 031263 ______ pcs ______ _________ ________ ________
f.4 Underwear (panties, etc.) 031264 ______ pcs ______ _________ ________ ________
f.5 Stockings, panty hose, socks, tights 031265 ______ pcs ______ _________ ________ ________
f.6 Raincoats, jackets, sweater, capes 031266 ______ pcs ______ _________ ________ ________
f.7 Other garments for girls, n.e.c. 031269 ______ pcs ______ _________ ________ ________
__________________________________ _______ ______ pcs ______ _________ ________ ________
g. Garments for Infants (< 1 year) 031270 XXXXXX XXXX ______ _____ _____
g.1 Dress 031271 ______ pcs ______ _________ ________ ________
g.2 Briefs and panties 031272 ______ pcs ______ _________ ________ ________
g.3 Shirt, tie-side shirt 031273 ______ pcs ______ _________ ________ ________
g.4 Pants, shorts, skirts 031274 ______ pcs ______ _________ ________ ________
g.5 Other garments for infants, n.e.c. 031279 ______ pcs ______ _________ ________ ________
__________________________________ _______ ______ pcs ______ _________ ________ ________
h. Garments for Sports Activity
(track suits, jogging suits, leotards, sweatshirts, 031280 ______ pcs ______ _ _ _ _ _ _ _____ _____
swimwear, etc.)
i. Other garments, n.e.c. 031290. ______ pcs ______ _ _ _ _ _ _ _____ _____
3. Other articles of clothing & clothing accessories 031300 XXXXXX XXXX ______ _____ _____
a. Ties, handkerchiefs, shawls, veils, belts, etc. 031310 ______ pcs ______ _________ ________ ________
b. Crash helmet for motorcycles and tricycles 031320 ______ pcs ______ _________ ________ ________
c. Sewing thread 031330 ______ pcs ______ _________ ________ ________
d. Other articles of clothing and clothing 031390 ______ pcs ______ _________ ________ ________
accessories, n.e.c.
PAGE 32

Unit
In Cash/ Received
On Credit as Gifts
(PESO)
4. Cleaning, Repair and Hire of Clothing 031400 XXXXXX XXXX ======== ======= =======
a. Dry-cleaning, laundering and dyeing of garments 031410 ______ pcs ______ _ _ _ _ _ _ _____ _____
a.1 Dry-cleaning, services 031411 ______ pcs ______ _________ ________ ________
a.2 Laundering, washing, cleaning and ironing 031412. ______ pcs ______ _________ ________ ________
services
a.3 Dyeing of garments and coloring services 031413 ______ pcs ______ _________ ________ ________
b. Darning, Mending, Repair and Altering of 031420 ______ pcs ______ _ _ _ _ _ _ _____ _____
Garments
c. Hire of Garments 031430 ______ pcs ______ _ _ _ _ _ _ _____ _____
FOOTWEAR 032000 XXXXXX XXXX ======== ======= =======
1. Shoes and other footwear 032100 XXXXXX XXXX ======== ======= =======
a. Footwear for Men (18 years old and above) 032110 ______ pair ______ _ _ _ _ _ _ _____ _____
a.1 Men’s shoes 032111 ______ pair ______ _________ ________ ________
a.2 Men’s slippers 032112 ______ pair ______ _________ ________ ________
a.3 Men’s rubber shoes 032113 ______ pair ______ _________ ________ ________
a.4 Other footwear for men (sandals, etc.) 032119 ______ pair ______ _________ ________ ________
_________________________________ ______ ______ pair ______ _________ ________ ________
b. Footwear for Women (18 years old and above) 032120 XXXXXX XXXX ______ _____ _____
b.1 Women’s shoes 032121 ______ pair ______ _________ ________ ________
b.2 Women’s slippers 032122 ______ pair ______ _________ ________ ________
b.3 Women’s rubber shoes 032123 ______ pair ______ _________ ________ ________
b.4 Other footwear for women (sandals/ 032129 ______ pair ______ _________ ________ ________
step-in, etc.)
________________________________ ______ ______ pair ______ _________ ________ ________
c. Footwear for Children (1-17 years old) boys 032130 XXXXXX XXXX ______ _____ _____
c.1 Children’s shoes 032131 ______ pair ______ _________ ________ ________
c.2 Children’s slippers 032132 ______ pair ______ _________ ________ ________
c.3 Children’s rubber shoes 032133 ______ pair ______ _________ ________ ________
c.4 Other footwear for children 032139 ______ pair ______ _________ ________ ________
(sandals/step-in, etc.)
________________________________ ______ ______ pair ______ _________ ________ ________
d. Footwear for Infants (< 1 year old) 032140 XXXXXX XXXX ______ _____ _____
d.1 Infants shoes 032141 ______ pair ______ _________ ________ ________
d.2 Infants slippers 032142 ______ pair ______ _________ ________ ________
d.3 Infants rubber shoes 032143 ______ pair ______ _________ ________ ________
d.4 Other footwear for infants, n.e.c 032149 ______ pair ______ _________ ________ ________
(sandals/step-in, etc.)
________________________________ ______ ______ pair ______ _________ ________ ________
e. Parts of Footwear (heels, soles, leggings, etc.) 032150 ______ pair ______ _ _ _ _ _ _ _____ _____
2. Repair of Footwear, Shoe Cleaning Services and 032200 ______ pair ______ _ _ _ _ _ _ _____ _____
Hire of Footwear
TOTAL 030000 XXXXX XXXXX ======== ======= =======

PAGE 33
D. HOUSING, WATER, ELECTRICITY, GAS AND OTHER FUELS
During the PAST MONTH (JUNE 2012), did you or any member of your family consume water, electricity, gas and
other fuels?
1 - YES 2 - NO, GO TO PAGE 35 (E)
Quantity VALUE CONSUMED (PESO)

Item Code Consumed In Cash/ Received
Total In Kind
/Frequency On Credit as Gifts
1. Actual Rentals for Housing 041000 XXXXXXX ======= =======
a. Actual Rentals Paid 041100 XXXXXXX _____ _____
a.1 Actual rentals paid by tenants or 041110 ________ ______ _______
subtenants occupying unfurnished
premises as their main residence
a.2 Actual rentals paid by tenants or 041120 ________ ______ _______
subtenants occupying furnished
premises as their main residence
a.3 Payment by households occupying 041130 XXXXXXX ______ _______
a room in a hotel or boarding
house as their main residence
a.4. Parking lot payments in connection 041140 XXXXXXX ______ _______
with the dwelling as main residence
a.5 Other actual rental paid in other 041190 XXXXXXX ______ _______
types of main residence
b. Other Actual Rentals 041200 XXXXXXX ____ _____
(Rental actually paid for secondary
residences)
2. Imputed Rentals for Housing 042000 XXXXXXX ____ _____
a. Imputed Rentals of Owners-Occupiers 042110 XXXXXXX ______ _______
(Imputed rentals of owners occupying
their main residence)
b. Other Imputed Rentals 042210 XXXXXXX ______ _______
(Imputed rentals for secondary
residence and households paying a
reduced rental or housed free)
3. Maintenance and repair of the dwelling 043000 XXXXXXX ======= =======
a. Materials for the maintenance and repair 043100 XXXXXX ____ _____ ______
a.1 Paints and varnishes 043110 __________ ______ _______ ________
a.2 Wallpaper, wall paper paste and 043120 __________ ______ _______ ________
fabric wall covering
a.3 Cement 043140 __________ ______ _______ ________
a.4 Carpentry, electrical, plumbing 043150 __________ ______ _______ ________
materials
a.5 Other materials for the maintenance 043190 __________ ______ _______ ________
and repair of the dwelling, n.e.c.
b. Services for the maintenance and repair 043200 __________ ____ _____ ______
(services of carpenters, painters, etc.)
PAGE 34
D. HOUSING, WATER, ELECTRICITY, GAS AND OTHER FUELS

Quantity VALUE CONSUMED (PESO)
Item Code Consumed In Cash/ Received
Total In Kind
/Frequency On Credit as Gifts
4. Water Supply and Miscellaneous Services 044000 XXXXXXX ____ _____

Relating to the Dwelling
a. Water supply 044100 _____ cu.m. ______ _______
b. Other services relating to the dwelling 044400 __________ ______ _______
________________________________ ______ __________ ______ _______
5. Electricity, Gas and Other Fuels 045000 XXXXXXX ____ _____ ______
______ ______ _______ ________
a. Electricity 045100 kwh
b. LPG 045200 _______ kg ______ _______ ________
c. Kerosene 045300 ______ liter ______ _______ ________
d. Fuelwood 045400 ___ bundle ______ _______ ______ ________
e. Charcoal 045440 _______ kg ______ _______ ______ ________
f. Other fuels (biomass residues, etc.) 045490 __________ ______ _______ ______ ________
________________________________ ______ __________ ______ _______ ______ ________
________________________________ ______ __________ ______ _______ ______ ________
TOTAL 040000 XXXXXXXX ======= ======= ====== =======
COMPUTATIONS/REMARKS:
PAGE 35
E. FURNISHINGS, HOUSEHOLD EQUIPMENT AND ROUTINE HOUSEHOLD MAINTENANCE
During the period JANUARY to JUNE 2012, did you or any member of your family purchase in cash or on credit
or receive as gift, any furnishings, household equipments and or pay for service fees or receive free routine maintenance
of the house?
1 - YES 2 - NO, GO TO PAGE 37 (F)
Unit
Total In Cash/ Received
Item Code Quantity Price
On Credit as Gifts
( PESO)
1. Furniture and Furnishings, Carpets and Other 051000 XXXXX XXXXX ======== ======= =======
Floor Coverings
a. Furniture and furnishings 051100 XXXXX XXXXX _ _ _ _ _ _ _ _ _ _ _ _____
a.1 Beds, sofas, couches, tables, chairs, 051110 ____ pcs ______ _________ ________ _______
cupboards, chest of drawers and bookshelves
a.2 Lighting equipments such as ceiling lights, 051120 ____ pcs ______ _________ ________ _______
standard lamps, and bedside lamps
a.3 Pictures, sculptures, engravings, tapestries, 051130 ____ pcs ______ _________ ________ _______
and other art objects including reproduction
of works of art and other ornaments
a.4 Other households furniture and furnishing, etc. 051190 ______ ______ _________ ________ _______
___________________________________ ______ ______ ______ _________ ________ _______
b. Carpets and other floor coverings 051200 ____ pcs ______ _ _ _ _ _ _ _ _ _ _ _ _____
c. Repair of furniture, furnishings and floor 051300 ____ pcs ______ _ _ _ _ _ _ _ _ _ _ _ _____
coverings
2. Household Textile 052000 XXXXXX XXXXX _ _ _ _ _ _ _ _ _ _ _ _____
a. Furnishing fabrics, curtain material, double 052010 ____ pcs ______ _________ ________ _______
curtains, awnings, door curtains and fabric blinds
b. Beddings such as pillows, bolster 052020 ____ pcs ______ _________ ________ _______
c. Bed sheets, pillow cases, blankets, mosquito nets 052030 ____ pcs ______ _________ ________ _______
d. Other household textiles, n.e.c. 052090 ______ ______ _________ ________ _______
________________________________________ ______ ______ ______ _________ ________ _______
________________________________________ ______ ______ ______ _________ ________ _______
3. Household Appliances 053000 XXXXX XXXXX ======== ======= =======
a. Major household appliances 053100 XXXXX XXXXX _ _ _ _ _ _ _ _ _ _ _ _____
a.1 Refrigerators/freezers and fridge-freezers 053110 ____ unit _______ _________ ________ _______
a.2 Washing machines, dryers, drying cabinets, 053120 ____ unit _______ _________ ________ _______
dishwashers, ironing and pressing machines
a.3 Cooking range/stove/hobs/ovens/microwave 053130 ____ unit _______ _________ ________ _______
ovens
a.4 Air conditioners/ventilators/water heaters, etc. 053140 ____ unit _______ _________ ________ _______
a.5 Other major household appliances 053190 ______ ______ _________ ________ _______
(sewing machine, knitting machine, etc.)
___________________________________ ______ ______ ______ _________ ________ _______
b. Small Electric Household Appliances 053200 XXXXX XXXXX _____ _____ _____
b.1 Electric fan 053210 ____ unit _______ _________ ________ _______
b.2 Rice cooker 053220 ____ unit _______ _________ ________ _______
PAGE 36
E. FURNISHINGS, HOUSEHOLD EQUIPMENT AND ROUTINE MAINTENANCE OF THE HOUSE
Unit
Total In Cash/ Received
On Credit as Gifts
(PESO)
b.3 Flat iron 053230 ____ unit _______ _________ ________ _______
b.4 Other small electric household appliances 053290 ____ unit _______ _________ ________ _______
__________________________________ ______ _______ _______ _________ ________ _______
__________________________________ ______ _______ _______ _________ ________ _______
c. Repair of household appliances 053300 ____ pcs ______ _ _ _ _ _ _ _ _ _ _ _ _____
4. Glassware, Tableware and Household Utensils 054000 ____ pcs ______ _ _ _ _ _ _ _ _ _ _ _ _____
5. Tools and Equipment for House and Garden 055000 ____ pcs ______ _ _ _ _ _ _ _ _ _ _ _ _____
6. Goods and Services for Routine Household 056000 XXXXX XXXXX ======== ======= =======
Maintenance
a. Non-durable household goods 056100 XXXXX XXXXX _ _ _ _ _ _ _ _ _ _ _ _____
a.1 Cleaning and maintenance products 056110 _______ _______ _________ ________ _______
(soaps, washing powders, washing liquids
detergents, softeners, etc.)
a.2 Articles of cleaning such as brooms, dust 056120 _______ _______ _________ ________ _______
pans, floor cloths, sponges, steel wool, etc.
a.3 Paper products (filters, table napkins, 056130 _______ _______ _________ ________ _______
aluminum foil, etc.)
a.4 Polishes, cream and other cleaning articles 056140 _______ _______ _________ ________ _______
a.5 Other non-durable household articles 056190 _______ _______ _________ ________ _______
(matches, candles, lamp wicks, clothes
hangers, pins, sewing needles, string, etc.)
b. Domestic and household services 056200 XXXXX XXXXX _ _ _ _ _ _ _ _ _ _ _ _____
b.1 Domestic services 056210 _______ _______ _________ ________ _______
b.1.1 Cook. 056212 _______ _______ _________ ________ _______
b.1.2 Maid. 056213 _______ _______ _________ ________ _______
b.1.3 Driver 056214 _______ _______ _________ ________ _______
b.1.4 Other domestic services, n.e.c. 056219 _______ _______ _________ ________ _______
b.2 Household services (window cleaning, 056230 _______ _______ _ _ _ _ _ _ _ _ _ _ _ _____
fumigation, disinfecting, and pest
examination)
b.3 Dry-cleaning, laundering, and dyeing of 056240 _______ _______ _ _ _ _ _ _ _ _ _ _ _ _____
household linen, household textiles and
carpets
b.4 Hire of furniture, furnishings, carpets, 056250 _______ _______ _ _ _ _ _ _ _ _ _ _ _ _____
household equipment and household linen
TOTAL 050000 XXXXX XXXXX ========= ======= =======
COMPUTATIONS/REMARKS
PAGE 37
F. HEALTH
During the period JANUARY to JUNE 2012, did you or any member of your family purchase in cash or on credit or
receive as gift, any medical products such as drugs and medicines, medical appliances and equipment, or pay or
receive free, any outpatient or inpatient medical services such as medical, dental and paramedical consultations and
services?
1 - YES 2 - NO, GO TO PAGE 39 (G)
Unit
In Cash/ Received
On Credit as Gifts
(PESO)
MEDICAL PRODUCTS, APPLIANCES and EQUIPMENT 061000 XXXXX XXXXX ======= ======= =======
1. Pharmaceutical Products 061100 XXXXX XXXXX _____ _____ _____
a. Medicinal preparations, medicinal drugs and patent 061110 XXXXX XXXXX _____ _____ _____
medicines
a.1 Infections and infestations 061111 ______ ______ ________ _______ _______
a.2 Hypertensive and cardiovascular diseases 061112 ______ ______ ________ _______ _______
a.3 Pain relief and consciousness (analgesic, etc.) 061113 ______ ______ ________ _______ _______
a.4 Allergy and respiratory diseases 061114 ______ ______ ________ _______ _______
a.5 Endocrine and central nervous system 061115 ______ ______ ________ _______ _______
b. Pharmaceutical products for nutrition and/or 061120 XXXXX XXXXX _____ _____ _____
prevent diseases
b.1 Serums and vaccines 061121 ______ ______ ________ _______ _______
b.2 Vitamins and minerals 061122 ______ ______ ________ _______ _______
b.3 Cod liver oil and halibut liver oil 061123 ______ ______ ________ _______ _______
b.4 Dietary supplements 061124 ______ ______ ________ _______ _______
b.5 Other pharmaceutical products or articles for 061129 ______ ______ ________ _______ _______
medical or surgical purposes disinfectant
c. Other medicinal preparations, medicinal drugs and
patent medicines 061190 XXXXX XXXXX _____ _____ _____
c.1 Local herbal medicines 061191 ______ ______ ________ _______ _______
c.2 Dermatology 061192 ______ ______ ________ _______ _______
c.3 Obstetrics 061193 ______ ______ ________ _______ _______
c.4 Urinary 061194 ______ ______ ________ _______ _______
c.5 Diagnostics 061195 ______ ______ ________ _______ _______
d. Other Medical Products 061200 ______ ______ _____ _____ _____
(Clinical thermometer, adhesive and non-adhesive
bandages, hypodermic syringes, hot-water bottles and
ice bags, medical hosiery items such as elasticated
stocking and knee-supports, pregnancy tests and
condoms and other mechanical conceptive devices)
PAGE 38
F. HEALTH
Unit
In Cash/ Received
On Credit as Gifts
(PESO)
e. Therapeutic Appliances and Equipment 061300 XXXXX XXXXX _____ _____ _____
e.1 Corrective eye glasses and contact lenses, 061310 ______ ______ ________ _______ _______
hearing aids, glass eyes
e.2 Dentures but not fitting costs 061370 ______ ______ ________ _______ _______
e.3 Other therapeutic appliances and equipment 061390 ______ ______ ________ _______ _______
n.e.c
OUTPATIENT MEDICAL SERVICES 062000 XXXXX XXXXX ======= ======= =======
1. Medical services 062100 XXXXX XXXXX ======= ======= =======
a. General medical services availed of (consultation, 062110 XXXXX XXXXX _____ _____ _____
physical check up and laboratory services)
a.1 Public medical service 062111 ______ ______ ________ ________ _______
a.2 Private medical services 062112 ______ ______ ________ _______ _______
b. Specialized medical services availed of 062120 XXXXX XXXXX _____ _____ _____
[analysis and interpretation of medical images
(X-ray, electrocardiogram, endoscopies, etc.)]
b.1 Public specialized medical service 062121 ______ ______ ________ _______ _______
b.2 Private specialized medical service 062122 ______ ______ ________ _______ _______
2. Dental Services 062200 ______ ______ _____ _____ _____

a. Public dental and laboratory services 062210 ______ ______ ________ _______ _______
b. Private dental and laboratory services 062220 ______ ______ ________ _______ _______
3. Paramedical Services 062300 _______ ______ _____ _____ _____

a. Medical analysis laboratories and X-ray centers 062310 ______ ______ ________ _______ _______
b. Freelance acupuncturists, optometrists,, etc., 062330 ______ ______ ________ _______ _______
c. Other paramedical services, n.e.c. 062390 ______ ______ ________ _______ _______
HOSPITAL SERVICES ( Inpatient Services) 063000 XXXXX XXXXX _____ _____ _____
a. Public hospital services 063010 _______ ______ ________ _______ _______
b. Private hospital services 063020 _______ ______ ________ _______ _______
TOTAL 060000 XXXXXX XXXXX ======== ======= =======
PAGE 39
G. TRANSPORT
During the PAST MONTH (JUNE 2012), did you or any member of your family pay in cash or on credit or receive as gift
any type of vehicles, spare parts and accessories, fuel and lubricants for personal transport, or pay for service fees or
receive free maintenance and repair of motor vehicles, or any transport services in the form of land transport fares, air
transport fares, and water transport fares?
1 – YES 2 - NO, GO TO NEXT PAGE 41 (H)
Unit
Frequency/ In Cash/ Received
Item Code Price Total
Quantity On Credit as Gifts
(PESO)
1. Purchase of vehicles 071000 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____
a. Motor cars 071100 _______ _____ _______ _______ _______
b. Motorcycle 071200 _______ ______ _______ _______ _______
c. Bicycle and tricycle 071300 _______ ______ _______ _______ _______
d. Animal drawn vehicles 071400 _______ ______ _______ _______ _______
2. Operation of Personal Transport Equipment 072000 XXXXX XXXX ======= ======= =======
a. Spare parts and accessories for personal transport 072110 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____
equipment
a.1. Tires 072111 _______ ______ _______ _______ _______
a.2. Batteries 072114 _______ ______ _______ _______ _______
a.3. Other spare parts or accessories 072119 _______ ______ _______ _______ _______
(spark plugs, fan belt, etc.)
__________________________________ ______ _______ ______ _______ _______ _______
__________________________________ ______ _______ ______ _______ _______ _______
b. Fuel and lubricants for personal transport 072200 XXXXX XXXX ======= ======= =======
equipment
b.1 Fuels for personal transport 072210 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
b.1,1 Diesel 072211 _______ ______ _______ _______ _______
b.1.2 Gasoline 072213 _______ ______ _______ _______ _______
b.1.3 Biofuel 072215 _______ ______ _______ _______ _______
b.1.4 Other fuels, n.e.c. 072219 _______ ______ _______ _______ _______
b.2 Lubricants, brake and transmission fluids, 072220 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
coolants and additives
b.3 Other fuel and lubricants for personal 072290 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
transport equipment, n.e.c.
___________________________________ ______ _______ ______ _______ _______ _______
___________________________________ ______ _______ ______ _______ _______ _______
c. Maintenance and repair of personal transport 072300 ________ ______ _ _ _ _ _ _ _ _ _ _ _____
equipment (wheel alignment, tune-up,
change oil, etc.)
d. Other services with respect of personal transport 072400 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____
equipment
d.1 Toll facilities and parking 072420 _______ ______ _______ _______ _______
d.2 Driving lessons, driving tests and driving 072430 _______ ______ _______ _______ _______
licenses
d.3 Other services n.e.c. 072490 _______ ______ _______ _______ _______
PAGE 40
G. TRANSPORT
Unit
(PESO)
3. Transport Services 073000 XXXXX XXXX ======= ======= =======
a. Passenger transport by railway 073100 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
b. Passenger transport by road 073200 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____
b.1 Jeepney fare 073210 _______ ______ _______ _______ _______
b.2 Bus fare 073220 _______ ______ _______ _______ _______
b.3 Taxi fare 073230 _______ ______ _______ _______ _______
b.4 Tricycle fare 073250 _______ ______ _______ _______ _______
b.5 Pedicab fare 073260 _______ ______ _______ _______ _______
b.6 Other transport payment by road, n.e.c. 073290 _______ ______ _______ _______ _______
_____________________________________ ______ _______ ______ _______ _______ _______
_____________________________________ ______ _______ ______ _______ _______ _______
c. Passenger transport by air 073300 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____
c.1 Domestic air fare 073310 _______ ______ _______ _______ _______
c.2 International air fare 073320 _______ ______ _______ _______ _______
d. Passenger transport by sea and inland 073400 XXXXX XXXX _ _ _ _ _ _ _ _ _ _ _____

d.1 Boat fare 073410 _______ ______ _______ _______ _______
d.2 Ferry/ship fare 073420 _______ ______ _______ _______ _______
d.3 Other passenger transport by sea and inland 073490 _______ ______ _______ _______ _______
Waterway, n.e.c. (jetski, speed boat, etc.)
e. Combined passenger transport, e.g., bus and 073500 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
RORO, etc.
f. Other purchased transport services (porters, etc.) 073600 _______ ______ _ _ _ _ _ _ _ _ _ _ _____
TOTAL 070000 XXXXXX XXXX ======= ======= =======
PAGE 41
H. COMMUNICATION
During the PAST MONTH (JUNE 2012), did you or any member of your family pay in cash or on credit, or receive as gift,
any telephone or telefax equipment, or pay for service fees or receive free postal services and telephone and telefax
services?
1 – YES 2 - NO, GO TO NEXT PAGE (I)
Unit
(PESO)
1. Postal Services 081000 XXXXX XXXXX _ _ _ _ _ _____ _____
2. Telephone and telefax equipment 082000 XXXXX XXXXX _ _ _ _ _ _____ _____
a. Cellular telephone 082010 _______ _______ ________ ________ ________
c. Landline telephone set 082020 _______ _______ ________ ________ ________
f. Other telephone and telefax equipment 082090 _______ _______ ________ ________ ________
______________________________________ ______ _______ _______ ________ ________ ________
______________________________________ ______ _______ _______ ________ ________ ________
3. Telephone and telefax services 083000 XXXXX XXXXX ======= ======= =======
a. Installation and subscription cost of personal 083010 _______ _______ _ _ _ _ _ _____ _____
telephone
b. Internet connection services 083040 _______ _______ _ _ _ _ _ _____ _____
c. Subscription of postpaid cellular phone 083060 _______ _______ _ _ _ _ _ _____ _____
d. Payment for prepaid communication 083080 XXXXX XXXXX _ _ _ _ _ _____ _____
d.1 Electronic load 083081 _______ _______ ________ ________ ________
d.2 Prepaid cell card 083082 _______ _______ ________ ________ ________
d.3 Prepaid telephone card 083083 _______ _______ ________ ________ ________
d.4 Prepaid internet card 083084 _______ _______ ________ ________ ________
d.5 Internet broadband 083085 _______ _______ ________ ________ ________
e. Other telephone and telefax services, n.e.c. 083090 _______ _______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

________________________________________ ______ _______ _______ ________ ________ ________
________________________________________ ______ _______ ______ ________ ________ ________
TOTAL 080000 XXXXX XXXXX ====== ====== ======
PAGE 42
I. RECREATION AND CULTURE

During the period JANUARY to JUNE 2012, did you or any member of your family purchase in cash/on credit, or receive
as gift any recreational equipments, musical instruments, or pay for service fees or receive free admission tickets to movies,
shows, cockfights, races, boxing, basketball, dances, fairs, and others?
1 - YES 2 - NO, GO TO PAGE 44 (J)
Unit
In Cash/ Received
Total On Credit as Gifts
(PESO)
1. Audio-visual photography and Information Processing 091000 XXXXX XXXX ======= ======= =======
a. Equipment for the reception, recording and 091100 XXXXX XXXX ======= ======= =======
reproduction of sound and pictures
a.1 Equipment for the reception of sound and 091110 XXXXX XXXX _____ _____ _____
pictures
a.1.1 Radio sets, car radios, radio clocks, etc. 091111 ______ _____ _______ _______ _______
a.1.2 Television sets, television aerials 091112 ______ _____ _______ _______ _______
of all types
a.2 Equipment for recording and reproduction 091120 XXXXX XXXX _____ _____ _____
of sound and pictures
a.2.1 CD, VCD, DVD, VHS and laser disc 091121 ______ _____ _______ _______ _______
player
a.2.2 Video-cassette players and recorders 091122 ______ _____ _______ _______ _______
a.3 Other equipment for reception, recording 091190 XXXXX XXXX _____ _____ _____
and reproduction of sound and pictures,.
n.e.c
a.3.1 Microphones 091191 ______ _____ _______ _______ _______
a.3.2 Earphones and headphones 091193 ______ _____ _______ _______ _______
a.3.3 Sing-along system 091195 ______ _____ _______ _______ _______
a.3.4 Other equipment for reception, 091199 ______ _____ _______ _______ _______
recording and reproduction of sound
and pictures, n.e.c.
b. Photographic and Cinematographic Equipment 091200 ______ _____ _____ _____ _____
and Optical Instruments (video cameras, etc.)
c. Information Processing Equipment 091300 XXXXX XXXX ======= ======= =======
c.1 Personal computers and visual display units, 091310 XXXXX XXXX _____ _____ _____
printers, software and miscellaneous
c.1.1 Desktop computers 091311 ______ ____ _______ _______ _______
c.1.2 Notebook, netbook or laptop 091312 ______ _____ _______ _______ _______
c.1.3 Printers 091313 ______ _____ _______ _______ _______
c.1.4 Computer software packages, such as 091315 ______ _____ _______ _______ _______
operating systems, application, etc.
c.1.5 Other personal computers and 091319 ______ _____ _______ _______ _______
visual units, software and
miscellaneous accessories, n.e.c.
c.2 Calculators 091320 ______ ____ _____ _____ _____
c.3 Other information processing equipment, n.e.c. 091390 ______ ____ _____ _____ _____
PAGE 43
I. RECREATION AND CULTURE

Unit
In Cash/ Received
Total On Credit as Gifts
(PESO)
d. Recording Media (records & compact discs, etc.) 091400 ______ _____ _____ _____ _____
e. Repair of Audio Visual, Photographic and 091500 ______ _____ _____ _____ _____
Information Processing Equipment
2. Other Major Durables for Recreation and Culture 092000 XXXXX XXXX ======= ======= =======
a. Major Durables for Outdoor Recreation 092100 XXXXX XXXX _____ _____ _____
a.1 Boats, outboard motors 092130 ______ _____ _______ _______ _______
a.2 Other major durables for outdoor recreation 092190 ______ _____ _______ _______ _______
n.e.c.
b. Musical Instruments and major durables for 092200 ______ _____ _____ _____ _____
indoor recreation (pianos, guitars, violins, etc.)
c. Maintenance and Repair of Other Major 092300 ______ _____ _____ _____ _____
Durables for Recreation and Culture
3. Other Recreational Items and Equipment, 093000 XXXXX XXXX _____ _____ _____
Gardens and Pets
a. Games, Toys and Hobbies 093100 ______ _____ _______ _______ _______
(card, stamp collections, video games, etc.)
b. Equipment for Sport, Camping and Open-Air 093200 ______ _____ _______ _______ _______
Recreation
c. Gardens, plants and flower 093300 ______ _____ _______ _______ _______
d. Pets and Related Products (pet foods, etc.) 093400 ______ _____ _______ _______ _______
4. Recreational and Cultural 094000 XXXXX XXXX _____ _____ _____
a. Recreational, and sporting services 094100 ______ _____ _______ _______ _______
(sport stadiums, tennis, volleyball, skating rinks,
etc.)
b. Cultural services (cinemas, theaters, etc.) 094200 ______ _____ _______ _______ _______
c. Game of chance (service charge for lotteries, 094300 ______ _____ _______ _______ _______
casinos, bingo hall, scratch cards, etc)
5. Newspaper, Books and Stationery 095000 XXXXX XXXX ======= ======= =======
a. Books 095100 ______ _____ _____ _____ _____
b. Newspaper and periodicals 095200 ______ _____ _____ _____ _____
c. Stationery and drawing materials 095400 ______ _____ _____ _____ _____
c.1 Writing pads, envelopes, notebooks, etc. 095410 ______ _____ _______ _______ _______
c.2 Pens, pencils, inks, erasers, etc. 095420 ______ _____ _______ _______ _______
c.3 Other stationery and drawing materials, n.e.c. 095490 ______ _____ _______ _______ _______
6. Package Holiday 096000 ______ _____ _____ _____ _____
(package holidays, half-day and one-day excursion
tours, pilgrimages)
TOTAL 090000 XXXXX XXXX ====== ======= =======

PAGE 44
J. EDUCATION
During the period JANUARY to JUNE 2012, did you or any member of your family pay in cash or on credit, or receive
as gift, payments for tuition fees, allowance for family members studying away from home, and other educational
expenses?
1 - YES 2 - NO, GO TO PAGE 46 (K)
Unit
In Cash/ Received
On Credit as Gifts
(PESO)
1. Tuition fees
a. Pre-primary 101100 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

a.1 Public pre-primary education 101111 _____ _____ ________ ________ ________
a.2 Private pre-primary education 101121 _____ _____ ________ ________ ________
b. Primary education 101200 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

b.1 Public primary education 101211 _____ _____ ________ ________ ________
b.2 Private primary education 101221 _____ _____ ________ ________ ________
c. Secondary education 102000 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

c.1 Public secondary education 102011 _____ _____ ________ ________ ________
c.2 Private secondary education 102021 _____ _____ ________ ________ ________
d. Post secondary non-tertiary education 103000 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

d.1 Public vocational or technical secondary 103011 _____ _____ ________ ________ ________
education
d.2 Private vocational or technical secondary 103021 _____ _____ ________ ________ ________
education
e. Tertiary (Baccalaureate and Post-Graduate) 104000 XXXX XXXX ======== ======== =======
Education
e.1 First stage of tertiary education 104100 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
e.1.1 Public tertiary education 104111 _____ _____ ________ ________ ________
e.1.2 Private tertiary education 104121 _____ _____ ________ ________ ________
e.2 Second stage of tertiary education 104200 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
e.2.1 Public tertiary education 104211 _____ _____ ________ ________ ________
e.2.2 Private tertiary education 104221 _____ _____ ________ ________ ________
2. Education Not Definable by Level 105000 _____ _____ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _

(review center, computer training, etc.)
PAGE 45
J. EDUCATION
Unit
In Cash/ Received
On Credit as Gifts
(PESO)
3. Allowance for Family Members Studying Away From 106000 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
Home
__________________________________________ ______ _____ _____ ________ ________ ________
__________________________________________ ______ _____ _____ ________ ________ ________
__________________________________________ ______ _____ _____ ________ ________ ________
4. Other Educational Expenses 107000 XXXX XXXX _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
a. School uniform and footwear 107300 _____ _____ ________ ________ ________
b. Computer rental services and printing service 107400 _____ _____ ________ ________ ________
TOTAL 100000 XXXX XXXX ======= ======= ======
PAGE 46
K. RESTAURANT AND HOTELS
(a) During the period JANUARY to JUNE 2012, did you or any member of your family consume any food from restaurants or hotels?
1 - YES 2 - NO, GO TO PAGE 48 (L)

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code Frequency Value Frequency Value Frequency Value
Consumed (ENTER Consumed (ENTER Consumed
CODE IN CODE IN
THE BOX. THE BOX.
(PESO) IF CODE “9”, (PESO) IF CODE “9”, (PESO)
SPECIFY) SPECIFY)
1. Restaurants, cafes and the like

a. Catering services provided by 111111 _______ __________ ____ _______ ________ _____ _______ _______
restaurants, buffets, bars, etc.
b. Catering services in places providing 111112 _______ __________ _ ____ _______ ________ ____ _______ _______
recreational, cultural, sporting or
entertainment services, swimming
pools, sport complexes, museums,
art galleries, nightclubs, dancing
establishments, etc.
c. Catering services on public transport 111113 _______ __________ ____ _______ ________ _____ _______ _______
(coaches, trains, boats, airplanes, etc.)
d. Sale of food products and 111120 _______ __________ ____ _______ ________ ____ _______ _______
beverages for immediate
consumption by kiosks, street vendors
and the like, including food products
and beverages dispensed ready for
consumption by automatic vending
machines
e. Sale of cooked dishes by 111130 _______ __________ _ ___ _______ ________ ____ _______ _______
restaurants for consumption
off their premises

1 - WEEKLY 2 – MONTHLY 3 – SIX MONTHS 9 – OTHERS SPECIFY
PAGE 47
K. RESTAURANT AND HOTELS

RECEIVED AS GIFTS
(6 months)
Reference Reference
Period Period
Item Code
Value Value Value
Frequency (ENTER Frequency (ENTER Frequency
Consumed CODE IN Consumed CODE IN Consumed
THE BOX. THE BOX.
IF CODE “9”, IF CODE “9”,
SPECIFY) SPECIFY
2. Canteens
a. Catering services of work canteens, 111210 _________ __________ ____ _________ __________ ____ ________ _________
office canteens, and canteen in schools,
universities and other educational
establishments
b. Catering services of university 111220

refectories, military messes and
wardrooms
_________ __________ ____ _________ __________ ____ ________ _________
3. Accommodation Services 112000
(Expenses on hotels, boarding houses,
motels, inns and establishments offering
“bed and breakfast”, condominium-hotel,
and other accommodation services, n.e.c.)
(c) How many family members are regularly eating outside the home? _________________________

PAGE 48
L. MISCELLANEOUS GOODS AND SERVICES
During the PAST MONTH (JUNE 2012) , did you or any member of your family purchase in cash or on credit,
or receive as gift, any materials for personal care and effects; pay for or receive free, social protection, insurance,
financial and other type of services?
1 - YES 2 - NO, GO TO PAGE 50 (M)

Quantity/ In Cash/ Received
Item Code Total
Frequency On Credit as Gifts
1. Personal Care 121000 XXXXXX ======== ======== ========

a. Hairdressing Salons and Personal Grooming 121100 XXXXXX ______ ______ ______
Establishments
a.1 Services of hairdressing salon and beauty 121110 _____ freq ________ ________ ________
parlor: manicure/pedicure, hot oil, rebonding,
cold wave/perm, hair trim, etc.
a.2 Barbershop services, eg. haircut, shave 121120 _____ freq ________ ________ ________
a.3 Spas, Saunas, Turkish bath, solaria and 121130 _____ freq ________ ________ ________
non-medical massages, etc.
a.4 Other personal grooming services, n.e.c. 121190 _____ freq ________ ________ ________
(aesthetic/cosmetic surgery, etc.)
_________________________________
b. Electric Appliances for Personal Care 121200 _____ pcs _____ _____ _____
(Electric razors and hair trimmers, hand-held
and hood hair dryers, curling tongs, etc.)
c. Other Appliances, Articles and Products for 121300 XXXXXX _____ _____ _____
Personal Care
c.1 Razors and hair trimmers, blades, scissors, 121310 _____ pcs ________ ________ ________
nail files, combs, toothbrushes, etc.
c.2 Personal hygiene (toilet soap, toothpaste, 121320 _____ ml ________ ________ ________
shampoo, conditioners, alcohol, etc.)
c.3 Beauty products (lipsticks, make-up, brushes, 121330 _____ ml ________ ________ ________
lotions, deodorants, perfumes, etc.)
c.4 Other products for personal care (toilet 121390 _________ ________ ________ ________
papers, napkins, shower caps, etc.)
___________________________________ _______ _________ ________ ________ ________
2. Personal Effects 123000 XXXXXX ======== ======== ========

a. Jewelry, clocks and watches 123100 _____ pcs _ _ _ _ _ _ ______ ______
b. Other personal effects 123200 _____ pcs _ _ _ _ _ _ ______ ______
b.1 Handbag, travelling bag, wallet, purse, etc. 123210 _____ pcs ________ ________ ________
b.2 Articles for babies (baby carriages, etc.) 123220 _____ pcs ________ ________ ________
b.3 Umbrella, sun-glass, fan, etc. 123240 _____ pcs ________ ________ ________
b.4 Funerary articles (coffins, gravestones, etc.) 123250 _____ pcs ________ ________ ________
b.5 Other personal effects, n.e.c. 123290 _________ ________ ________ ________
3. Social protection (retirement homes for elderly 124000 _________ _ _ _ _ _ _ ______ ______
persons, residences for disabled persons, etc.)
______________________________________ _______ _________ ________ ________ ________
PAGE 49
L. MISCELLANEOUS GOODS AND SERVICES

Quantity/ In Cash/ Received
Item Code Total
Frequency On Credit as Gifts
4. Insurance (life and non-life insurance) 125000 _________ _ _ _ _ _ _ ______ ______
a. Life insurance 125100 _________ ________ ________ ________
b. Insurance connected with the dwelling 125200 _________ ________ ________ ________
c. Insurance connected with health 125300 _________ ________ ________ ________
d. Insurance connected with transport 125400 _________ ________ ________ ________
e. Other insurance 125500 _________ ________ ________ ________
______________________________________ _______ _________ ________ ________ ________
5. Financial services (financial charges of banks, 126200 XXXXXX ______ ______ ______
money changers, etc.)
_______________________________________ _______ _________ ________ ________ ________
6. Other services, n.e.c. (fees for legal services, 127000 XXXXXX ______ ______ ______
funeral charges, payment fo photocopies, fees for
the issue of birth, marriage and death certificates,
service charges in bayad centers, etc.)
_______________________________________ _______ _________ ________ ________ ________
TOTAL 129000 XXXXXXX ======== ======== ========
PAGE 50
M. OTHER EXPENDITURES
During the period JANUARY to JUNE 2012, did you or any member of your family pay taxes such as income
tax, real estate tax, and other direct taxes and or give gifts and contribution to others in cash or in kind?
1 - YES 2 - NO, GO TO (N) BELOW
Item Code In Cash In Knd
1. Taxes 130100 _______

a. Income tax 130110 ___________
b. Real estate tax 130120 ___________
c. Other direct taxes (community tax certificate, etc.) 130130 ___________
2. Gifts and contributions to Others 130200 _______ _______
a. Gifts and assistance to private individuals outside the 130210 ___________ ____________
family
b. Contributions to church and religious institutions 130220 ___________ ____________
c. Contributions and donations to other institutions 130230 ___________ ____________
d. Other gifts and contributions (birthdays/weddings/ 132040 ___________ ____________
anniversaries, holiday season’s gift, etc.)
3. Other (losses due to fire and theft, etc.) 132090 _______ _______
TOTAL 130000 =========== ===========
N. OTHER DISBURSEMENTS
During the period JANUARY to JUNE 2012, did you or any member of your family incur any expenses, in cash
or on credit, on other disbursement such as purchase or amortization of real property, payment of cash loans,
installments for appliances or car bought before 2012 on installment basis, loans granted to persons outside the
family, deposits, investments and others?
1 - YES 2 - NO, GO TO NEXT PAGE (PART III)

Frequency/
Item Code Value
Quantity
1. Purchase/amortization of real property 140100 ________ _____________
2. Payments of cash loan (principal) 140200 ________ _____________
3. Installments for appliances, etc. bought before 2012 140300 ________ _____________
4. Installments for personal transport bought before 2012 140400 ________ _____________
5. Loans granted to persons outside the family 140500 ________ _____________
6. Amount deposited in banks/investments 140600 ________ _____________
7. Major repair of the house 140700 ________ _____________
8. Construction of new house 140800 ________ _____________
9. Other disbursements 140900 ________ _____________
(Withholding taxes from current income, payment for
goods/services acquired/availed of outside reference
period, back rentals paid during reference period,
investment services, financing/non-banking services,
architectural and interior designing, property rights
bought during the reference period, etc.)
TOTAL 140000 XXXXXXXX ============

PAGE 51
PART III
HOUSING CHARACTERISTICS
At the time of visit . . . [ FIRST VISIT - JULY 2012 ]
(a) In what type of building/house does the family reside?
1 - Single house
2 - Duplex
3 - Multi-unit residential (three units or more)
4 - Commercial/industrial/agricultural (office, factory, and others)
5 - Institutional living quarter (hotel, hospital, and others)
6 - Other housing unit (boat, cave, and others)
(b) What type of construction materials are the roofs made of?
1 - Strong materials (galvanized iron, aluminum, tile, concrete, brick, stone, asbestos)
2 - Light materials (cogon, nipa , anahaw)
3 - Salvaged/makeshift materials
4 - Mixed but predominantly strong materials
5 - Mixed but predominantly light materials
6 - Mixed but predominantly salvaged materials
7 - Not applicable
(c) What type of construction materials are the outer walls made of?
1 - Strong materials
(galvanized iron, aluminum, tile, concrete, brick, stone, wood, plywood, asbestos)
2 - Light materials (bamboo, sawali, cogon, nipa, anahaw)
3 - Salvaged/makeshift materials
4 - Mixed but predominantly strong materials
5 - Mixed but predominantly light materials
6 - Mixed but predominantly salvaged materials
7 - Not applicable
(d) What is the tenure status of the housing unit and lot occupied by your family?
1 - Own or owner-like possession of house and lot
2 - Rent house/room including lot
3 - Own house, rent lot
4 - Own house, rent-free lot with consent of owner
5 - Own house, rent-free lot without consent of owner
6 - Rent-free house and lot with consent of owner
7 - Rent-free house and lot without consent of owner
8 - Not applicable
(e) What is the floor area of the housing unit? _____________ square meter
(f) When was this building/house built?
(year)
(g) How many bedrooms does this housing unit have?

PAGE 52
PART III. HOUSING CHARACTERISTICS

(h) Were there any alterations or additions to the house or other major renovations done in the
housing unit during the past six months?
1 YES 2 NO
(i) What kind of toilet facilities does the family have in the house?
1- Water-sealed, sewer septic tank, used exclusively by household
2- Water-sealed, sewer septic tank, shared with other household
3- Water-sealed, other depository, used exclusively by household
4- Water-sealed, other depository, shared with other household
5- Closed pit
6- Open pit
7- Others (pail system, and others)
0- None
(j) Is there any electricity in the building/house?

1 YES 2 NO
(k) What is the family’s main source of water supply?

01 - Own use, faucet, community water system
02 - Shared, faucet, community water system
03 - Own use, tubed/piped deep well
04 - Shared, tubed/piped deep well
05 - Tubed/piped shallow well
06 - Dug well
07 - Protected spring
08 - Unprotected spring
09 - Lake, river, rain, and others
10 - Peddler
11 - Bottled water
12 - Others, specify _____________________________
(l) If answer to (k) is any of the codes 02 to 08, how far is this water source from your house? ________ meters
(m) How many of each of the following items does the family own? 1
01. Radio/radio cassette 2
02 Television set 3
03 CD/VCD/DVD player
4
04. Component/Stereo set
5
05. Refrigerator/Freezer
6
06. Washing machine
7
07. Air conditioner
8
08. Car, jeep, van
09. Landline/wireless telephone 9
10. Cellular phone 10
11. Personal computer (desktop, laptop, notebook, netbook, and others) 11

12. Stove with oven/gas range 12
13. Motorized boat/banca 13
14. Motorcycle/tricycle 14
PAGE 53
PART IV - SOCIAL PROTECTION

During the period JANUARY to JUNE 2012, did you or any member of your family receive payment from
any of the following sources? (ENCIRCLE CODE)
a. Pension (Government) 1 YES 2 NO If Yes, how much? _________

b. Pension (Private) 1 YES 2 NO If Yes, how much? _________
c. Survivor’s Benefit 1 YES 2 NO If Yes, how much? _________
d. National Health Insurance Program (Philhealth) 1 YES 2 NO If Yes, how much? _________
e. Training for Work Scholarship Program (TWSP) 1 YES 2 NO If Yes, how much? _________
f. Agrarian Reform Community Development Program (ARCDP) 1 YES 2 NO If Yes, how much? _________
g. Community-Based Employment Program (CBEP) 1 YES 2 NO If Yes, how much? _________
h. Disability Benefit 1 YES 2 NO If Yes, how much? _________
i. Scholarship Benefits and Student Financial Assistance
i.1 Government 1 YES 2 NO If Yes, how much? _________
i.2 Private 1 YES 2 NO If Yes, how much? _________
j. Others, specify ________________________________ 1 YES 2 NO If Yes, how much? _________
QUESTIONS ON PANTAWID PAMILYANG PILIPINO PROGRAM (4Ps)

1. From January to June 2012, did you or any member of your family receive benefits from the
Pantawid Pamilyang Pilipino Program (4Ps)
1 YES 2 NO, GO TO NEXT PAGE (PART V)
2. When did you or that family member become a beneficiary of the 4Ps?
MONTH YEAR
3. How many times were these benefits received from January to June 2012?
NUMBER OF TIMES
4. How much do/did you receive per month from the 4Ps?
AMOUNT
5. How much did you receive in total from the 4Ps from January to June 2012?
AMOUNT
6. Of the amount that you received from the program from January to June 2012,
how much did you allocate for the following:
AMOUNT AMOUNT
a. Food g. Savings
b. Education h. Investment/Capital for business
c. Medical Care i. Alcohol, cigarette, gambling
d. Clothing j. Recreation, special occasion
e. Rent, housing, utility k. Others, specify ___________
f. Debt payment _________________________
PAGE 54
NOTE TO THE INTERVIEWER:
PART V REVIEW PART III (HOUSING CHARACTERISTICS)

PAGE 51. IF Part III.(d) IS CODE 4 OR 6, AND THERE
INCOME AND OTHER RECEIPTS IS A CORRESPONDING SHARP SIGN (#) BEFORE
THE CODE. ENTER THE TOTAL VALUE FOR THE
A. SALARIES AND WAGES FROM EMPLOYMENT SEMESTER IN COLUMN (11). REVIEW ALSO ALL
SECTIONS OF PART II FOR VALUE OF
GOODS AND SERVICES RECEIVED AS FRINGE
BENEFITS FROM EMPLOYER AND ENTER IN
A1. SALARIES AND WAGES FROM REGULAR EMPLOYMENT COLUMN (11).
A1. 1 Agricultural
During the period JANUARY to JUNE 2012, did you or any member of your family receive regularly salaries and wages from employment in agricultural sectors,
in cash (including allowances, honoraria, tips, bonus, commissions) and in kind (including housing, food, grocery, clothing, and medical benefits)?
1 - YES 2 - NO, GO TO PAGE 55 (A1.2)

C A S H E A R N I N G S E A R N I N GS I N K I N D
First Name {Occu-
Line Kind of [Industry Basic Allowances Basic Housing,
of Occupation pation
No. Industry Code] Salaries Honoraria, Total Salaries Clothing, Total
Family Member Code]
and Wages Tips, etc. and Wages Food, etc.
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
____ ________________ _____________ ________ _____________ ________ __________ __________ __________ __________ __________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ __________ __________ __________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ __________ __________ __________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ __________ __________ __________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ __________ __________ __________ __________
TOTAL 910100 ========= ========= ========= ========== ========== ==========
PAGE 55
A1. 2 Non-agricultural
During the period JANUARY to JUNE 2012, did you or any member of your family receive regularly salaries and wages from employment in agricultural sectors,
in cash (including allowances, honoraria, tips, bonus, commissions) and in kind (including housing, food, grocery, clothing, and medical benefits)?
1 - YES 2 - NO, GO TO PAGE 56 (A2)

First Name [Occu-
Line Kind of [Industry Basic Allowances Basic Housing,
of Occupation pation Total
No. Industry Code] Salaries Honoraria, Total Salaries Clothing,
Family Member Code]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
____ ________________ _____________ ________ _____________ _________ __________ __________ ________ _________ _________ ________
____ ________________ _____________ ________ _____________ ________ __________ __________ ________ _________ _________ ________
____ ________________ _____________ ________ _____________ ________ __________ __________ ________ _________ _________ ________
____ ________________ _____________ ________ _____________ ________ __________ __________ ________ _________ _________ ________
____ ________________ _____________ ________ _____________ ________ __________ __________ ________ _________ _________ ________
=========
TOTAL 910200 ========= ========= ========= ========== = ==========
PAGE 56
NOTE TO THE INTERVIEWER:
REVIEW PART III (HOUSING CHARACTERISTICS)

A2. SALARIES AND WAGES FROM SEASONAL/OCCASIONAL EMPLOYMENT PAGE 51. IF Part III.(d) IS CODE 4 OR 6, AND THERE
IS A CORRESPONDING SHARP SIGN (#) BEFORE
THE CODE. ENTER THE TOTAL VALUE FOR THE
SEMESTER IN COLUMN (11). REVIEW ALSO ALL
A2.1 Agricultural SECTIONS OF PART II FOR VALUE OF GOODS
AND SERVICES RECEIVED AS FRINGE BENEFITS
FROM EMPLOYER AND ENTER IN COLUMN (11).
During the period JANUARY to JUNE 2012, did you or any member of your family receive salaries and wages from agricultural sectors as seasonal/occasional
workers (e.g. fruit picker) in cash (including allowances, honoraria, tips, bonus, and commissions) and in kind (housing, food, grocery, clothing and medical benefits)?
1 - YES 2 - NO, GO TO NEXT PAGE (A2.2)

First Name [Occu-
Line Kind of [Industry Basic Allowances, Basic Housing,
Family Member Code]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
____ ________________ _____________ ________ _____________ _________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
TOTAL 910300 ========= ========== ======== ========== ========= =========
P
PAGE 57
A2.2 Non-agricultural
During the period JANUARY to JUNE 2012, did you or any member of your family receive salaries and wages from non-agricultural sectors as seasonal/occasional
workers (e.g. building construction laborer) in cash (allowances, honoraria, tips, bonus, and commissions) and in kind (food, etc.)?
1 - YES 2 - NO, GO TO PAGE 58 (B)

First Name [Occu-
Line Kind of [Industry Basic Allowances, Basic Housing,
Family Member Code]
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
____ ________________ _____________ ________ _____________ _________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
____ ________________ _____________ ________ _____________ ________ __________ __________ _________ _________ _________ __________
TOTAL 910400 ========= ========== ======== ========== ========= =========
PAGE 58
B. NET SHARE OF CROPS, FRUITS AND VEGETABLES PRODUCED, AQUACULTURE PRODUCTS

HARVESTED OR LIVESTOCK AND POULTRY RAISED BY OTHER HOUSEHOLDS
During the period JANUARY to JUNE 2012, did you or any member of your family receive net share of
crops, fruits and vegetables produced, fishing or livestock and poultry raised by other households?
If yes, how much was sold for cash or consumed by the family?
1 - YES 2 - NO, GO TO PAGE 59 (C)
Total Net
Value
Item Value of Sold for Cash
Code Consumed
Share
1. Cereals 920100 _______ _______ _ _ _ _ _ __ _
(a) Rice 920110 ___________ ___________ __________
(b) Corn 920120 ___________ ___________ __________
(c) Other cereals 920130 ___________ ___________ __________
2. Fruit 920200 _______ _______ ______
3. Vegetables 920300 _______ _______ ______
4. Fishing 920400 _______ _______ ______
5. Livestock and Poultry 920500 _______ _______ ______
6. Livestock and Poultry Products 920600 _______ _______ _______
7. Others (specify)
____________________________ 920700 _______ _______ _______
TOTAL 920000 ========== ========== ==========
PAGE 59
C. OTHER SOURCES OF INCOME

C1. CASH RECEIPTS, GIFTS, SUPPORT, RELIEF AND OTHER FORMS OF ASSISTANCE FROM
ABROAD
During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash any receipt, gift or other forms of assistance from
abroad?
1 - YES 2 - NO, GO TO (C2) BELOW
Item Code In Cash
1. Cash received from family members who are Overseas 930110 _______________
Contract Workers (OCW)
2. Cash received from family members who are working 930120 _______________
abroad other than OCW
3. Pensions, retirement, workmen’s compensation and other 930130 _______________
benefits
4. Cash gifts, support, relief, etc. from abroad 930140 _______________
5. Dividends from investment abroad 930150 _______________
TOTAL 930100 ===============
C2. CASH RECEIPTS, SUPPORT, ASSISTANCE AND RELIEF FROM DOMESTIC SOURCE
During the period JANUARY to JUNE 2012 did you or any member of your family receive in cash any gift, support, assistance or relief from
domestic source?
Source Code In Cash
1. Other families 930210 _______________

2. Government institutions 930220 _______________
a. Conditional Cash Transfer (CCT/4Ps) 930221 _______________
b. Others, specify _________________ 930222 _______________
3. Private institutions 930230 _______________
TOTAL 930200 ===============

C3. RENTALS RECEIVED FROM NON-AGRICULTURAL LANDS, BUILDINGS, SPACES AND
OTHER PROPERTIES
During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, rentals
from non-agricultural land, buildings, spaces or other properties?
1 - YES 2 - NO, GO TO NEXT PAGE (C4)
Item Code In Cash In Kind
1. Land 930310 __________ ___________

2. Buildings 930320 __________ ___________
3. Spaces 930330 __________ ___________
4. Other properties 930340 __________ ___________
TOTAL 930300 ========= ===========

PAGE 60
C4. INTEREST
During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, interest from bank deposits and
loans extended to other families?
1. Interest from bank deposits 930410 ___________ XXXXXXXXX

2. Interest from loans extended to other 930420 ___________ ___________
families
TOTAL 930400 =========== ===========
C5. PENSION AND RETIREMENT, WORKMEN’S COMPENSATION AND SOCIAL SECURITY

BENEFITS
During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, pension and retirement, workmen’s
compensation, or social security benefits?
1. Pension and retirement 930510 ___________ ___________

2. Workmen’s compensation 930520 ___________ ___________
3. Social security benefits 930530 ___________ ___________
TOTAL 930500 =========== ===========
C6. DIVIDENDS FROM INVESTMENT

During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, any
dividend from investment (stocks, bonds, etc.)?
Code In Cash In Kind
What is the total value 930700 ============= =============
C7. OTHER SOURCES OF INCOME NOT ELSEWHERE CLASSIFIED

During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, other
sources of income not elsewhere classified such as royalties and income of family members below 10 years old?
1 - YES 2 - NO, GO TO NEXT PAGE (D)

Specify Source __________________________
Code In Cash In Kind
What is the total value 931100 ============= =============

PAGE 61
D. OTHER RECEIPTS
During the period JANUARY to JUNE 2012, did you or any member of your family receive in cash or in kind, other
receipts such as sale of real property; sale of personal property such as (clothing, jewelry, etc.); loans from other
families, business firms and government institutions for current consumption and investment; payment received for
loans granted to others (excluding interest); withdrawals from savings/business equity; net winnings from
gambling, profits from sale of stocks, back pay and proceeds from insurance, inheritance or other receipts?
1 – YES 2 - NO, GO TO PAGE 62 (E)
1. Sale of real property 940010 ____________ ____________
2. Sale of personal property 940020 ____________ ____________
3. Loans from other families 940030 ____________ ____________
4. Loans from business firms (including sari-sari

stores and government institutions 940040 ____________ ____________
5. Payments received for loans granted to others 940050 ____________ ____________
6. Withdrawals from savings/business equity 940060 ____________ ____________
7. Net winnings from gambling, sweepstakes and 930080 ____________ ____________

Raffle
8. Profits from sale of stocks, bonds and

real and personal property 930090 ____________ ____________
9. Back pay and proceeds from insurance 930100 ____________ ____________
10. Inheritance 930110 ____________ ____________
11. Other receipts (tax refund, dowries, prizes 940070 ____________ ____________
received from tournaments, etc.)
TOTAL 940000 =========== ===========
PAGE 62
E. CHECKLIST FOR FAMILY SUSTENANCE AND ENTREPRENEURIAL ACTIVITIES
(a) During the period JANUARY to JUNE 2012, did you or any member of your family produce goods mainly for
home consumption?
1 - YES 2 - NO
(b) During the period JANUARY to JUNE 2012, did you or any member of your family engage as operator in any of
the following entrepreneurial activities?
1. CROP FARMING AND GARDENING such as growing of palay, corn, roots 1. 1 - YES 2 - NO
and tubers, vegetables, fruits, nuts, orchids, ornamental plants, etc.
2. LIVESTOCK AND POULTRY RAISING such as raising of carabaos, cattle, 2. 1 - YES 2 - NO

hogs, horses, chicken, ducks, etc. and the production of fresh milk, eggs, etc.
3. FISHING such as capture fishing (with a boat of three tons or less); gathering 3. 1 - YES 2 - NO
fry, shells, seaweeds, etc. ; and culturing fish, oyster, mussel, etc.
4. FORESTRY AND HUNTING such as tree planting (ipil-ipil), firewood 4. 1 - YES 2 - NO

gathering, small-scale logging (excluding concessionaires), charcoal making,
gathering forestry products (cogon, nipa, rattan, bamboo , resin, gum, etc.)
or hunting wild animals/birds
5. WHOLESALE AND RETAIL including market vending, sidewalk vending and 5. 1 - YES 2 - NO
peddling
6. MANUFACTURING such as mat weaving, tailoring, dressmaking, bagoong 6. 1 - YES 2 - NO

making, fish drying, etc.
7. COMMUNITY, SOCIAL, RECREATIONAL AND PERSONAL SERVICES 7. 1 - YES 2 - NO

such as medical and dental practice, practice of trade, operation of schools,
restaurants and hotels, etc.
8. TRANSPORTATION, STORAGE AND COMMUNICATION SERVICES 8. 1 - YES 2 - NO

such as operation of jeepneys or taxis, storage and warehousing activities,
messenger services, etc.
9. MINING AND QUARRYING such as mineral extraction like salt making, gold 9. 1 - YES 2 - NO
mining, gravel, sand and stone quarrying, etc.
10. CONSTRUCTION or repair of a house, building or any structure 10. 1 - YES 2 - NO
11. ACTIVITIES NOT ELSEWHERE CLASSIFIED including electricity, gas and 11. 1 - YES 2 - NO
water; financial, insurance, real estate and business services
INSTRUCTIONS/REMINDERS TO INTERVIEWERS:
FOR A ‘YES’ ANSWER IN (a), FILL UP THE SECTION ON FAMILY SUSTENANCE ACTIVITIES (NEXT PAGE).
FOR EVERY ‘YES’ ANSWER IN (b), MAKE SURE THE PORTION IN PART V (PAGE 64-75) CORRESPONDING TO
THE ACTIVITY ENGAGED IN IS FILLED UP.
IF THE FAMILY IS NOT ENGAGED IN ANY ENTREPRENEURIAL AND FAMILY SUSTENANCE ACTIVITY,
END INTERVIEW.
PAGE 63
F. FAMILY SUSTENANCE ACTIVITIES

During the period JANUARY to JUNE 2012, did you or any member of your family produce goods mainly for
home consumption? If yes, how much was consumed by the family?
1 - YES 2 - NO, REFER TO CHECKLIST ON PAGE 62
Type of Activity Code Net Receipts Value Consumed
1. Fishing, gathering shells, snail, seaweeds, 950100 ________ ________

corals, etc.
2. Logging, gathering forest products like firewood 950500 ________ ________
3. Hunting and trapping 950600 ________ ________
4. Farming, gardening 950800 ________ ________
a) Cereals 950810 ____________ ____________
b) Fruits 950820 ____________ ____________
c) Vegetables 950830 ____________ ____________
d) Others, specify ________________________ 950840 ____________ ____________
5. Raising livestock and poultry 950900 ________ ________
a) Livestock and poultry 950910 ____________ ____________
b) Livestock and poultry products 950920 ____________ ____________
TOTAL 950000 =========== ===========
PAGE 64
PART VI
A. ENTREPRENEURIAL ACTIVITIES
A1. CROP FARMING AND GARDENING

(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in crop farming
and gardening such as growing of palay, corn, roots and tubers, vegetables, fruits, nuts, etc.?
(b) During the period JANUARY to JUNE, 2012, did you or any member of your family harvest crops, fruits and
vegetables? If yes, how much was consumed by the family or given away as gifts?
Value
Area/Trees Total Value Given
Item Code Production
Harvested Value Consumed Away
As Gifts
1. Cereals 001210 XXXXXXX XXXXXXX ______ ______ ______

a. Palay 920110 ________ ________ ________ ________ ________
b. Corn 920120 ________ ________ ________ ________ ________
c. Others, specify _____ ________ ________ ________ ________ ________
________________________ _____ ________ ________ ________ ________ ________
2. Fruits and vegetables 001220 XXXXXXX XXXXXXX ______ ______ ______

a. Fruits 920220 ________ ________ ________ ________ ________
b. Vegetables 920230 ________ ________ ________ ________ ________
c. Cassava 920240 ________ ________ ________ ________ ________
d. Camote 920250 ________ ________ ________ ________ ________
e. Coconut 920260 ________ ________ ________ ________ ________
f. Others, specify _____ ________ ________ ________ ________ ________
________________________ _____ ________ ________ ________ ________ ________
3. Others (including orchids

and ornamental plants) 001240 XXXXXXX XXXXXXX ______ ______ ______
a. Tobacco 920030 ________ ________ ________ ________ ________
b. Coffee 920710 ________ ________ ________ ________ ________
c. Others, specify _____ ________ ________ ________ ________ ________
(including copra)
_______________________ _____ ________ ________ ________ ________ ________
TOTAL 001200 XXXXXXX XXXXXXX ======== ======== ========

PAGE 66
A2. LIVESTOCK AND POULTRY RAISING

(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in livestock or
poultry raising such as raising of carabaos, cattle, horses, hogs, chickens, ducks, etc. and produce any
livestock and poultry products such as milk, eggs, etc.?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family dispose of any
livestock and poultry whether sold, consumed or given away, or did you or any family member produce
livestock/poultry products? If yes, how much was consumed by the family or given away as gifts?
Value
Number/ Total Value
Item (Specify) Code Given Away
Quantity Value Consumed
As Gifts
1. Livestock and poultry XXXXXXX 002210 ______ ______ ______
a. Pigs ________ 920410 _________ _________ _________

b. Cattle ________ 920420 _________ _________ _________
c. Chicken ________ 920430 _________ _________ _________
d. Carabao ________ 920440 _________ _________ _________
e. Others, specify ________ ______ _________ _________ _________
________________________ ________ ______ _________ _________ _________
________ ______ _________ _________ _________
2. Livestock/poultry products XXXXXXX 002220 ______ ______ ______
a. Milk ________ 920510 _________ _________ _________

b. Eggs ________ 920540 _________ _________ _________
c. Others, specify ________ ______ _________ _________ _________
TOTAL XXXXXXX 002200 ========= ========= =========
COMPUTATION /REMARKS:
PAGE 67
A2. LIVESTOCK AND POULTRY RAISING

(c) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in
cash or in kind, in raising the livestock and poultry disposed of, or in producing the livestock/poultry products?
1 - YES 2 - NO, GO TO NEXT PAGE (A3)
Item Code In Cash In Kind Total
1. Acquisition cost of stock 002310 ___________ ___________ ___________
2. Feeds 002320 ___________ ___________ ___________
3. Medicine 002330 ___________ ___________ ___________
4. Labor 002340 ___________ ___________ ___________
5. Fuel and oil 002350 ___________ ___________ ___________
6. Electricity 002360 ___________ ___________ ___________
7. Other expenses 002370 ___________ ___________ ___________
TOTAL 002300 ========== ========== ==========
COMPUTATION OF NET INCOME FROM LIVESTOCK AND POULTRY RAISING :
Code [JANUARY - JUNE 2012]
TOTAL VALUE 002200 ________________

LESS : TOTAL COSTS 002300 ________________
NET INCOME 002000 ==============
P COMPUTATIONS/REMARKS:
PAGE 68
A3. FISHING
(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in such
activities such as capturing fish (with a boat of three tons or less), gathering fry, shells, seaweeds and other
aquatic animals or products and culturing fish, oyster, mussel, etc.?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family catch/gather/harvest
fish or aquatic products? If yes, how much was consumed by the family or given away as gifts?
Value
Total Value Given
Item Quantity Code
Value Consumed Away
As Gifts
1. Fish and other products _______ kg 003210 __________ __________ __________

2. Fry gathered _______ kg 003220 __________ __________ __________
3. Shells and other products gathered _______ kg 003230 __________ __________ __________
4. Fish harvested _______ kg 003240 __________ __________ __________
5. Oyster and mussel harvested _______ kg 003250 __________ __________ __________
6. Other products harvested _______ kg 003260 __________ __________ __________
TOTAL VALUE XXXXXX 003200 ======== ======== ========
cash or in kind, in catching, gathering or culturing the fish or aquatic products reported above?
1. Acquisition cost of fry/fingerlings 003310 ___________ ___________ ___________

2. Fertilizer, feeds and pesticide 003320 ___________ ___________ ___________
3. Wages of hired labor and
paid family members 003330 ___________ ___________ ___________
4. Ice 003340 ___________ ___________ ___________
5. Fuel and oil 003350 ___________ ___________ ___________
6. Other expenses 003360 ___________ ___________ ___________
TOTAL COSTS 003300 ========= ========= =========
COMPUTATION OF NET INCOME FROM FISHING :
Code [JANUARY – JUNE 2012]
TOTAL VALUE 003200 ________________

LESS : TOTAL COSTS 003300 ________________
NET INCOME 003000 ===============

PAGE 69
A4. FORESTRY AND HUNTING

(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in such forestry
activities as tree planting (ipil-ipil), firewood gathering, small scale logging excluding concessionaires,
charcoal
making, gathering forestry products (cogon, nipa, rattan, bamboo, resin, gum, etc.), or hunting wild
animals/birds?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family dispose of (whether sold,
consumed, or given away) forestry products gathered or wild animals/birds hunted? If yes, how much was
consumed by the family or given away as gifts?
Value
Total Value
Item Quantity Code Given Away
Value Consumed
As Gifts
1. Charcoal ________ 004210 _________ _________ _________

2. Firewood ________ 004220 _________ _________ _________
3. Logs ________ 004230 _________ _________ _________
4. Other forest products ________ 004240 _________ _________ _________
5. Wild animals/birds ________ 004250 _________ _________ _________
TOTAL VALUE XXXXXX 004200 ======= ======= =======
(c) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in cash
or in kind, in gathering forest products or hunting wild animals/birds disposed of?
1. Wages of hired labor and 004310 ______________ ______________ ______________

paid family members
2. Fuel and oil 004320 ______________ ______________ ______________
3. Others 004330 ______________ ______________ ______________
TOTAL COSTS 004300 =========== =========== ===========
COMPUTATION OF NET INCOME FROM FORESTRY AND FISHING:
TOTAL VALUE 004200 ________________

LESS : TOTAL COSTS 004300 ________________
NET INCOME 004000 ===============
PAGE 70
A5. WHOLESALE AND RETAIL

(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in any wholesale
or retail activity including market vending, sidewalk vending and peddling?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family sell goods either on
wholesale or retail basis?
Code
How many months did you sell such goods? 005210 .
What is the average gross sale per month? 005220 X __________________
TOTAL SALES 005200 ==================
cash or in kind, in selling such goods?
1. Cost of goods sold 005310 ________ ___________ ________
2. Others (specify) _________________ 005320 ________ ___________ ________
TOTAL COSTS 005300 ========== ========== ==========
COMPUTATION OF NET INCOME FROM WHOLESALE AND RETAIL:
TOTAL SALES 005200 _____________________
less : TOTAL COSTS 005300 __________________
NET INCOME 005000 ================
PAGE 71
A6. MANUFACTURING
(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in such
manufacturing activities as mat weaving, tailoring, dressmaking, bagoong making and fish drying?
(b) Describe major activity _______________________________ PSIC Code : ____________
(c) During the period JANUARY to JUNE 2012, did you or any member of your family sell any of the goods
manufactured?
1 - YES 2 - NO, GO TO [A6 (d)] BELOW
Code
How many months did you sell such goods? 006210 .
What is the average gross sale per month? 006220 X _________________
TOTAL SALES 006200 ==================
(d) During the period JANUARY to JUNE 2012, did you or any member of your family consume any of the
goods manufactured?
1 - YES 2 - NO, GO TO NEXT PAGE [A6 (e)]
Item Quantity Code Value
1. Cereal preparation ________________ 006310 ________________
2. Preparation from roots and tubers ________________ 006320 ________________
3. Fruit and vegetable preparation ________________ 006330 ________________
4. Meat preparation ________________ 006340 ________________
5. Processed fish and marine products ________________ 006350 ________________
6. Other food items ________________ 006360 ________________
7. Alcoholic beverages (Native wine) ________________ 006370 ________________
8. Other non-food items (specify)

______________________________________ ________________ 006380 ________________
TOTAL CONSUMED XXXXXXXXXXXXX 006300 ============
PAGE 72
A6. MANUFACTURING
(e) During the period JANUARY to JUNE 2012, did you or any member of your family give away as gifts any of
the goods manufactured?
1 - YES 2 - NO, GO TO [A6 (f)] BELOW
Item Quantity Code Value
1. Cereal preparation __________ 006410 __________
2. Preparation from roots and tubers __________ 006420 __________
3. Fruit and vegetable preparation __________ 006430 __________
4. Meat preparation __________ 006440 __________
5. Processed fish and marine products __________ 006450 __________
6. Other food items __________ 006460 __________
7. Alcoholic beverages (native wine) __________ 006470 __________
8. Other non-food items (specify)

____________________________ __________ 006480 __________
TOTAL GIFTS XXXXXXXX 006400 ==========
(f) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in
cash or in kind, in manufacturing the goods reported?
1. Raw materials 006510 __________ __________ __________
2. Others (specify) _______________ 006520 __________ __________ __________
TOTAL COSTS 006500 ========= ========= =========
COMPUTATION OF NET INCOME FROM MANUFACTURING :
Code [JANUARY - JUNE 2012 ]
TOTAL SALES 006200 _________________
PLUS : TOTAL CONSUMED 006300 _________________
PLUS : TOTAL GIFTS 006400 _________________
LESS : TOTAL COSTS 006500 _________________
NET INCOME 006000 ================

PAGE 73
A7. COMMUNITY, SOCIAL, RECREATIONAL AND PERSONAL SERVICES

(a) During the period JANUARY to JUNE 2012, did you or any member of your family operate any activity
providing community, social, recreational and personal services such as medical and dental practice, practice
of trade, operation of schools, restaurants and hotels, etc?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family receive any
compensation/payment for rendering such services?
1 - YES 2 - NO, GO TO [A7 (c)] BELOW
Code
How many months did you render service
or practice your trade? 007210 .
What is the average gross receipt per month? 007220 X ___________________
TOTAL GROSS RECEIPTS 007200 =================
(c) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in cash or
in kind, in rendering such services?
1. Materials and supplies 007310 ________ ________ _________

2. Others (specify) ________________________ 007320 ________ ________ _________
TOTAL COSTS 07300 ======== ======== ===========
COMPUTATION OF NET INCOME FROM COMMUNITY, SOCIAL, RECREATIONAL AND

PERSONAL SERVICES :
Code [ JANUARY - JUNE 2012 ]
TOTAL GROSS RECEIPTS 007200 ____________

less : TOTAL COSTS 007300 ____________
NET INCOME 007000 ============
PAGE 74
A8. TRANSPORTATION, STORAGE AND COMMUNICATION SERVICES

(a) During the period JANUARY to JUNE 2012, did you or any member of your family operate any activity
providing transportation, storage and communication services such as operation of jeepneys or taxis,
storage and warehousing activities, tour and travel agencies, messenger services etc.?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family receive any
compensation/payment for rendering such services?
Code
How many months did you operate or render 008210 .
services?
What is the average gross receipt per month? 008220 X ___________________
TOTAL GROSS RECEIPTS 008200 =================
cash or in kind, in rendering such services?
1. Fuel and oil 008310 _________ _________ _________
2. Maintenance and repair 008320 _________ _________ _________
3. Others (specify) ______________________ 008330 _________ _________ _________
TOTAL COSTS 008300 ========= ========= =========
COMPUTATION OF NET INCOME FROM TRANSPORTATION, STORAGE AND

COMMUNICATION SERVICES:
TOTAL GROSS RECEIPTS 008200 __________________

less : TOTAL COSTS 008300 __________________
NET INCOME 008000 =================
PAGE 75
A9. MINING AND QUARRYING

(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in mining
and quarrying such as salt mining, gravel and sand quarrying, etc?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family dispose of mining and
quarrying products?
Code
What is the total gross receipts? 009200 ___________________
(c) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses,
in cash or in kind, in producing the products disposed of?
1. Materials and supplies 009310 _________ _________ _________
2. Fuels 009320 _________ _________ _________
3. Others (specify) _________________ 009330 _________ _________ _________
TOTAL COSTS 009300 ========= ========= =========
COMPUTATION OF NET INCOME FROM MINING AND QUARRYING:
Code [JANUARY – JUNE 2012 ]
TOTAL GROSS RECEIPTS 009200 _______________
less : TOTAL COSTS 009300 _______________
NET INCOME 009000 ==============
PAGE 76
A10. CONSTRUCTION
(a) During the period JANUARY to JUNE 2012, did you or any member of your family contract services for the
construction or repair of a house, building or any structure?
(b) During the period JANUARY to JUNE 2012, did you or any member of your family receive payment for the
construction activity?
Code
What is the total gross receipts 010200 ___________________
(c) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in cash or
in kind, for the construction activity?
1. Wages of hired labor and

paid family members 010310 ____________ ____________ ______________
2. Materials and supplies 010320 ____________ ____________ ______________
3. Others (specify) _______________ 010330 ____________ ____________ ______________
TOTAL COSTS 010300 ========== ========== ==========
COMPUTATION OF NET INCOME FROM CONSTRUCTION:
TOTAL GROSS RECEIPTS 010200 ________________
less : TOTAL COSTS 010300 ________________
NET INCOME 010000 ===============
PAGE 77
A11. ENTREPRENEURIAL ACTIVITIES NOT ELSEWHERE CLASSIFIED (INCLUDING
ELECTRICITY, GAS AND WATER; FINANCIAL, INSURANCE, REAL ESTATE AND
BUSINESS SERVICES
(a) During the period JANUARY to JUNE 2012, did you or any member of your family engage in other
entrepreneurial activities not elsewhere classified such as legal, accounting and engineering services;
advertising services; and machinery and equipment renting and leasing?
1 - YES 2 - NO, END INTERVIEW
PSIC Code: ________________
(b) Describe major activity : _____________________________________________________
(c) During the period JANUARY to JUNE 2012, did you or any member of your family receive professional
or service fees for this activity?
1 - YES 2 - NO, GO TO [A11 (d)] BELOW
Code
What is the total gross receipt for the semester? 011200 _____________________
(d) During the period JANUARY to JUNE 2012, did you or any member of your family incur expenses, in
cash or in kind, in this activity?
1 - YES 2 - NO, END INTERVIEW
1. Materials and supplies 011310 __________ __________ ___________
2. Fuels and lubricants 011320 __________ __________ ___________
3. Others (specify) _________________ 011330 __________ __________ ___________
TOTAL COSTS 011300 ========= ========== ==========
COMPUTATION OF NET INCOME FROM ENTREPRENEURIAL ACTIVITIES N.E.C.:
TOTAL GROSS RECEIPTS 011200 _______________
less : TOTAL COSTS 011300 _______________
NET INCOME 011000 ==============
PAGE 78
PART VII
EVALUATION OF THE HOUSEHOLD RESPONDENT BY THE INTERVIEWER
Q1 How would you assess the respondent/s?
1 Interested? 1 YES 2 NO
2 Cooperative? 1 YES 2 NO
3 Attentive? 1 YES 2 NO
4 Approachable/Friendly? 1 YES 2 NO
Q2 How many respondent/s did you interview? _________
Name of the respondent/s Relationship to HH head
_________________________________________
_________________________________________
_________________________________________
Q3 Did you make any callback?
1 YES 2 NO
If Yes, reason for callback __________________________________________________
Who is your respondent during the callback?
Name of the respondent/s Relationship to HH head
________________________________________
________________________________________
REMARKS:

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Confidentiality: FIES FORM 1 (2012)

REPUBLIC OF THE PHILIPPINES

2012 FAMILY INCOME AND EXPENDITURE SURVEY

PART I - A. IDENTIFICATION AND OTHER INFORMATION

PROVINCE Name of Household Head:

BGY Interview Status

_______________________________ ______________ _______________________________ ____________

Interviewer’s Code ………………. Supervisor’s Code ……………….

B. PARTICULARS ABOUT THE FAMILY

[ FIRST VISIT - JULY 2012 ]

1 YES 2 NO, GO TO ITEM 2

2. What is the type of this household?

3. How many members are there in the family?

4. How many family members are below 5 years old?

5. How many family members are 5 to 17 years old?

1 - YES 2 - NO 3 - NOT APPLICABLE

ENCIRCLE APPROPRIATE CODES. ENTER CODES IN BOXES PROVIDED.

1 - YES 2 - NO, GO TO PAGE 7 (01.1.2)

Unit Quantity Value Reference Quantity Value Reference Quantity Value

1. Rice (in all forms)

CODES FOR THE REFERENCE PERIOD

01.1.1 BREAD AND CEREALS

Unit Quantity Value Reference Quantity Value Reference Quantity Value

4. Other Cereal Preparation

CODES FOR THE REFERENCE PERIOD

1 - WEEKLY 2 – MONTHLY 3 – SIX MONTHS 9 – OTHERS, SPECIFY

01.1.1 BREAD AND CEREALS

Unit Quantity Value Reference Quantity Value Reference Quantity Value

5. Bread and Other Bakery Products

6. Pasta Products in All Forms

CODES FOR THE REFERENCE PERIOD

1 - YES 2 - NO, GO TO PAGE 9 (01.1.3)

(b) How much is your consumption of the following?

1. Meat, Fresh, Chilled or Frozen

CODES FOR THE REFERENCE PERIOD

4. Preserved or Processed Meat and

CODES FOR THE REFERENCE PERIOD

01.1.3 FISH AND SEAFOOD

1 - YES 2 - NO, GO TO PAGE 12 (01.1.4)

(b) How much is your consumption of the following?

1. Fish, Fresh, Chilled or Frozen

CODES FOR THE REFERENCE PERIOD

01.1.3 FISH AND SEAFOOD

2. Dried, Smoked or Salted Fish

CODES FOR THE REFERENCE PERIOD

01.1.3 FISH AND SEAFOOD

4. Fish otherwise Prepared or

CODES FOR THE REFERENCE PERIOD

01.1.4 MILK, CHEESE AND EGGS

1 - YES 2 - NO, GO TO PAGE 14 (01.1.5)

a. Condensed milk 011421 ______ ______ml ________ _____ _______ml ________

CODES FOR THE REFERENCE PERIOD

01.1.4 MILK, CHEESE AND EGGS

6. Cheese and Curd

CODES FOR THE REFERENCE PERIOD

01.1.5 OILS AND FATS

1 - YES 2 - NO, GO TO NEXT PAGE (01.1.6)

a. Margarine 011521 ______ ______g ________ _____ _______g ________

CODES FOR THE REFERENCE PERIOD

1 - YES 2 - NO, GO TO PAGE 17 (01.1.7)

CODES FOR THE REFERENCE PERIOD

3. Fruit, Nuts and Edible Seeds

4. Preserved Fruit and Fruit-based

CODES FOR THE REFERENCE PERIOD

___________ _

a. Condensed milk 011421 ml __ _ _ml ____

a. Margarine 011521 g __ _ _g ____

b. Muscovado 011812 __ _kg ____ _ _kg ____

4. Chocolates 011840 __ _g ____ _ _g ____

b. Iodized salt 011912 __ _g ____ _ g ___

d. Vetsin 011924 __ _g ____ _ g ___

3. Beer 021300 __ _ml ____ _ _ml ____

1. Cigarettes containing tobacco 022010 _sticks _ sticks ____

2. Cigars, 022020 _sticks _ sticks ____

4. Water Supply and Miscellaneous Services 044000 XXXXXXX _

2. Dental Services 062200 __ _ _ ___

3. Paramedical Services 062300 ___ _ _ ___

1. Postal Services 081000 XXXXX XXXXX _ _ _ _ _ _ _

2. Telephone and telefax equipment 082000 XXXXX XXXXX _ _ _ _ _ _ _