1. Governorate ____

2. Qadah ____

3. Nahiya ____

4. Environment

5. District name or mahalla name ____

6. Village name ____



7. Zone number ____

8. Street number ____

9. House census number ____

10. Household series number in zone ____

11. Number of households in the residential unit ____

12. Number of bedrooms ____

Mark with an [x] the correct answer.

13. Ownership of the residential unit

Private sector

Government sector



14. Size of the rented residential unit

[] 1 All unit
[] 2 One room
[] 3 Two rooms
[] 4 Three rooms and more

15. Monthly rent (I. D.) ____

[The following instructions apply to questions 16 to 26]
Fill for each household living alone in the residential unit, if occupied by more than one household, only one of the households should respond.

16. Type of residential unit

17. Wall construction material

18. Total number of rooms in the residential unit ____

19. Is there any bathroom in the occupied unit?

20. Is there any water closet?

21. Are the bathroom and the water closet in the same place?

22. Is there any kitchen?

23. Is the living unit equipped with electricity?

24. Is the living unit equipped with a telephone?

25. Source of drinking water in the residential unit

26. Drainage of waste water

27. To be filled by people living in establishments (hotels, clinics, prisons, etc.)

[Personal Questionnaire]

[Questions 28-75 were to record for each person in a household.]

28. Person's series number ____

29. Name ____

30. Father's name ____

31. Grandfather's name ____

32. Family name (surname)____

33. Mother's name and her father's name ____

34. Residential status

35. Relationship to the head of the household

36. Sex

37. Date of birth

To be filled by people age 12 and older
[Applies to questions 38-45]

38. Marital status

For married, divorced or widowed persons (both sexes)
[Applies to questions 39-40]

39. Date of first marriage____

40. Number of marriages____

For married males only

41. Number of wives legally under his protection ____

For married, divorced and widowed women

[Questions 42 to 45 are for married, divorced and widowed women]

42. Duration of marriage

43. Total number of live births during married life

44. Total number of living children

45. Total number of live births during the period 10/17/1996-10/16/1997

For persons six years old and more
[Applies to questions 46-52]

46. Labor force information

47. Main occupation ____

48. Economic activity ____

49. Employment status

50. Sector

51. Work time

52. Main source of living

53. Survival status of parents

54. Place of birth

Residential status

Previous place of residence:

For those who were born before the 10/17/1987
[Applies to questions 59-61]

Usual place of residence before the population census in 1987

For Iraqis only
[Applies to questions 62-64]

62. Ethnicity ____

63. Religion ____

64. Local and foreign languages spoken by the person ____

Questions 65-67 are for students continuing their studies

65. Educational level

66. Class or level ____

67. Specialization (for vocational schools, institutes, colleges and high studies students) ____

The fields (68-70) are filled for those who are more than (10) years old, excluding the students who were born in 1987 or earlier.

68. Persons without certificate

69. For persons with certificates (mark with an [x] the highest certificate)

70. Specialization (for graduates of institutes, vocational schools, colleges and post graduates) ____

The fields (71, 72) are filled for all handicapped persons without recognition to the sex or age.

71. Type of disability

72. Reasons for disability

Information about private certificates

73. Name of office ____

74. Number of register book ____

75. Number of page ____