WOMAN'S NAME: ____

IDENTIFICATION:

PROVINCE OR PREFECTURE: ____

CIRCLE: ____

MUNICIPALITY: Autonomous Center/Rural Commune: ____

CENTER: ____

PRIMARY UNIT NUMBER: ____

SECONDARY UNIT NUMBER: ____

LEVEL: ____

HOUSEHOLD NUMBER: ____

WOMAN'S LINE NUMBER: ____

HOUSEHOLD ADDRESS: ____

REGION _____

PROVINCE OR PREFECTURE ___

CIRCLE ___

MUNICIPALITY/RURAL MUNICIPALITY ____

OTHER CENTER ___

SURVEY DISTRICT _

RABAT-CASA/LARGER CITY/SMALL CITY/RURAL

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

HOUSEHOLD ADDRESS ____

NAME OF HEAD OF HOUSEHOLD ________