ONLINE PANELIST CONSENT FORM

Introduction

Good Morning /Good Afternoon/Good Evening. My name is ..................................... from

Tacar Kenya, an independent market and social research firm based in Nairobi, Kenya.

Tacar is carrying out a mobile phone panel survey on behalf of MDI, a global market research
company,

Your household has been randomly selected to participate in this mobile phone panel survey. I
would like to invite you to take part in the survey. First, I will talk to you about the study and
answer any question that you may have.

Purpose of the Research Project

Project Beach is a nationwide mobile phone panel survey in Kenya. The project seeks to record
and measure consumers’ beverage drinking habits during a 7day period.

The study will interview 880 respondents across Kenya.

Project Beach is divided into two phases, the first phase is known as the panel recruitment in
which we seek to collect data by having a face-to-face interview. This is what we are doing
today. The second phase of project Beach is an online self-completion survey. In the online
survey panellists will participate by filing and submitting an e-diary via an application installed
on their smartphone.

Procedures

To facilitate the submission of data for this survey we shall give you data bundles to cover for
costs of filling and submitting the diaries. The data bundles will be sent direct from the office to
your preferred line.

Confidentiality Clause

Your responses or information about this household will not be shared with anyone outside the
study team. The reports might say for example, “30% of Kenyans are not consuming carbonated
drinks”. No personal information will ever be shared.

Benefits

There is no direct benefit to you for participating in the survey. Neither you nor the household
member will receive compensation. However, you have the potential to improve the quality
and contribute to the development of better products. A token of appreciation in terms of
airtime will be sent to you after successful submission of diaries for 7 days.

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Risks for participation

There is no risk for participation in this survey.

Who do I call if I have a question?

If you have a question or concern about this survey, please contact Hamida Omar on
…………………………Between 8.00am to 5.00pm.

I have given you highlights of the project Beach, are you okay with us installing Refresh me App
in your phone to participate in this survey?

YES 1 THANK THE RESPONDENT AND CONTINUE

NO 2 ESTABLISH REASON FOR REFUSAL AND ADDRESS. IF HE/SHE REFUSES THANK
HIM/ HER AND RECORD.LOOK FOR ANOTHER RESPONDENT ACORDING THE
QUOTA

“I have read/understood the consent form and i voluntarily agree to participate in the study.

Panellist name Signature Date

____________________ _____________________ __________________

PROVIDE A COPY OF THE CONSENT FORM TO THE PANELIST

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