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General Population Census 1970
Supervised on the ____ 1970
By (name) ________
Checked on the ____ 1970
By (name) ________
____ Region
____ Circumscription or municipality
____ Canton
____ Town or village
____ Neighborhood
____ Farm
____ Hamlet
____ Compound number
[] Compound in farm
[] Compound in hamlet
[] Electricity generator
[] Running water
[] Well
[] River
[] Public pump
This sheet, which takes the place of the household sheet, will also be used for the population counted separately: it will be completed by the head of the institution or with their aid.
The population counted separately includes: the following categories of persons:
- Persons being treated in a health institution (for more than 6 months).
- Detainees in centers, on remand, on bail and so on.
- Persons in care in beggars' homes, psychiatric hospitals and so on.
- Members of religious communities
- Pupils boarding in high schools, colleges, seminaries and so on.
- Workers housed in temporary worksites and having no other domicile
- Person who are temporarily absent from the establishment (soldiers on leave, residential students on holiday and so on).
On the contrary, are not part of the population except:
- The staff of institutions (director, steward and so on)
- Day pupils and half-boarders
- Worksite workers who have a personal domicile
For all these persons, the census will be carried out by household.
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____ Series number
____ Household sheet number
____ Compound number
Please write in printed letters
2. Surname and first names ________
3. Relationship to the head ____
8b. Months _ _
____ [] 9b. Other village of the same region
____ [] 9c. Other region
____ [] 9d. Other country
10. Nationality or ethnic group ____
____ 12b. Level
13. Professional training ____
____ 14b. Position in the enterprise
____ 14c. Activity of the enterprise
15. Are you repatriated from an African country?
____ 15b. Length of stay in that country
____ 15c. Date of return to Togo