Form 1

District :========================V.D.C./Municipality :=============================== Ward :+========Village/Settlement/Tole : ==============================

House No. :+=========== Household No. : ========== Total Persons : ========== Male: ======== Female: ========

Full Name of all

What is

What is

What is

What is

What is

What is

What is

What is

S.

members of the

.........

.........

.........

.........

.........

.........

.........

.........

N.

Household

Sex?

Age ?

Caste/

Relation

Religion?

Spoken

Citizenship?

Type of

(The head of the household

(for males

(completed

Ethnicity?

to Head

(Codes must

Language ?

(Citizenship

Disability ?

should be recorded

code 1 &

age must

(Caste of

of the HH ?

be encircled

(Mother

as to the

(Codes must be

first followed by other

for females

be given

the

(codes must

according to

tongue must

country must

encircled

members of the household

code 2 must

and 00

individual

be encircled

the religion

be specified

been circled

which denote

serially without missing

be encircled)

for age

person

which denote

practiced)

in code 1 &

and specified

appropriate

anybody)

less than

should be

appropriate

second  Langu-

for others)

disable)

a year)

written)

Relation)

age in Code 2)

1

2

3

4

5

6

7

8

9

10

1

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

1. Male

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

..............

..............

5. Parents

5. Jain

Language

5. Multiple Disablity

2. Female

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

2

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

3

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

4

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

5

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

6

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......

7

1. Head

1. Hindu

1. Mother

1. Nepali

1. Physical disable

1. Male

2. Spouse

2. Boudha

Tongue

2. Indian

2. Blind

3. Son/daughter

3. Ishlam

..............

3. Chinese

3. Deaf

..............

..............

4. Dat.-in-law

4. Kirat

2. Second

4. Other  .......

4. Mentally retarted

2. Female

5. Parents

5. Jain

Language

5. Multiple Disablity

6. Other ......

6. Isai

..............

6. Not disable

7. Others .......