NAME OF LOCALITY _____
NAME OF HOUSEHOLD HEAD ______
PROVINCE ______
DISTRICT _____
SECTOR _____
CLUSTER NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____

LOCALITY NAME ________

NAME OF HOUSEHOLD HEAD ______

PROVINCE ______

DISTRICT ________

CLUSTER NUMBER ______

STRUCTURE NUMBER __________

HOUSEHOLD NUMBER _________

URBAN/RURAL (URBAN=1, RURAL=2) ________

CITY/LARGE TOWN/SMALL TOWN/VILLAGE

PROVINCE____

DISTRICT____

SECTOR____

NAME OF HOUSEHOLD HEAD____

CLUSTER NUMBER____

HOUSEHOLD STRUCTURE NUMBER____

HOUSEHOLD NUMBER____