FARITANY (REGION) NAME ______
FIVONDRONAMPOKOTANY (DISTRICT) NAME ______
CLUSTER NUMBER _____
HOUSEHOLD UNIT NUMBER _____

PLACE NAME ____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER ____
HOUSEHOLD UNIT NUMBER ____
REGION (FARITANY) ____

PLACE NAME _______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION (FARITANY) ______
VILLAGE ______

PLACE NAME ______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
SEQUENTIAL NUMBER OF THE HOUSEHOLD WITHIN THE CLUSTER _______
BUILDING NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION ______
VILLAGE ______

ANTANANARIVO/OTHER CITY/RURAL AREA?