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Government of Pakistan
Census Organization
Housing, Economic and Demographic Survey
Population Census of Pakistan 1972

Sample Area Code ____
Structure Number ____
Household Number ____

1. Name of the Head of Household ____
2. Respondent's name ____
3. Father's / husband's name ____
4. Respondent's relationship to the head of household ____

Part I
Housing characteristics and household facilities for both urban and rural areas

1. What are the primary materials of the walls of the housing unit occupied by this household?

[] 1 Cement finished (concrete, baked bricks or stones)
[] 2 Mud finished (with baked bricks or stones)
[] 3 Sun-dried bricks or mud
[] 4 G.I. / C.I. / asbestos / plastic
[] 5 Wood / bamboo / thatch
[] 6 Other material (specify ____)

2. What are the primary materials of the roof of this housing unit?

[] 1 Cement finished (concrete, baked bricks or stones)
[] 2 Mud finished (with baked bricks or stones)
[] 3 Sun-dried bricks or mud
[] 4 G.I. / C.I. / asbestos / plastic
[] 5 Wood / bamboo / thatch
[] 6 Other material (specify ____)

3. When was this housing unit constructed?

[] 1 Less than 5 years ago
[] 2 5 to 10 years ago
[] 3 More than 10 years ago but after Independence
[] 4 Before Independence

4. What is the type of tenure of this housing unit?

[] 1 Owner occupied
[] 2 Rent free
[] 3 Rent paid

If rent paid, what is the gross amount of rent paid per month?

Rs. ____

5. How many rooms are in this housing unit? (Do not count verandahs, balconies, durhl, kitchen, bath rooms and latrines)

____ rooms

6. Is there a kitchen in this housing unit?

[] 1 Yes
[] 2 No
[] 3 Shared

7. Is there a bath room in this housing unit?

[] 1 Yes
[] 2 No
[] 3 Shared

8. What latrine facilities are available to this housing unit?

[] 1 Flush system inside the housing unit (municipal sewerage connected)
[] 2 Flush system inside the housing unit (septic tank connected)
[] 3 No-flush system inside the housing unit
[] 4 Any facility outside the housing unit
[] 5 None/ open county, etc.

9. What is the primary source of drinking water for this housing unit?

[] 1 Running water (piped) inside the housing unit
[] 2 Running water (piped) outside the housing unit
[] 3 Hand pump inside the housing unit
[] 4 Hand pump outside the housing unit
[] 5 Well
[] 6 Pond, tank, river, spring, etc. (specify ____)

10. What fuel is mainly used by this housing unit for cooking?

[] 1 Wood
[] 2 Coal or charcoal
[] 3 Kerosene oil
[] 4 Gas (piped or stored)
[] 5 Electricity
[] 6 Cow dung
[] 7 Other (specify ____)

11. What does this housing unit mainly use for lighting purposes?

[] 1 Electricity
[] 2 Kerosene oil
[] 3 Other (specify ____)

For urban areas only
12. How is the garbage of this housing unit disposed of?

[] 1 Regular municipal collection from the housing unit/structure
[] 2 Dumped at designated location for municipal collection
[] 3 No arrangements for regular municipal collection (dumped outside the house on the street etc)

13. What is the type of surface of the street from where there is access to this housing unit?

[] 1 Pucca (metalled)
[] 2 Semi-Pucca (stone or brick)
[] 3 Kutcha
[] 4 No regular street at all
[] 5 Any other type (specify ____)

Part II
Particulars of the members of this household

Household number ____
Structure number ____
Sample area code ____

1. Line number: Serial number of household member ____

2. Name
Write full name of each member of this household starting with the head of household ____

3. Relationship to the head of household
Write relationship of each person listed to the head of household ____

4. Sex

[] 1 Male
[] 2 Female

5. Age (in completed years) _ _

6. Marital status

[] 1 Never married
[] 2 Married
[] 3 Widowed
[] 4 Divorced

7. Disability

[] 1 Blind
[] 2 Deaf and dumb
[] 3 Crippled
[] 4 Other handicapped

Internal migration
[Questions 8-10.]

8. Birth place (district/country)
Write the name of district in which the person was born. Give name of the country, if born outside Pakistan. ____

9. Duration of continuous residence in this locality (write duration in completed years) ____

10. Where were you living (place of usual residence) when India attacked Pakistan in September 1965? (Write name of district with urban/rural indication, e.g. Multan (U) Sukkur (R), etc. ____

Educational characteristics
(For persons 5 years of age and above)
[Questions 11-14.]

11. Literacy

[] 1 Literate with formal education
[] 2 Literate without formal education
[] 3 Illiterate

12. School attendance

[] 1 Attending general
[] 2 Attending specialized
[] 3 Attending Madrassah
[] 4 Left school
[] 5 Not attended any school

13. Highest grade/level passed in general or specialized or Madrassah education
Write highest grade/level passed in general, specialized, Madrassah education, viz. Matric M.Sc., B.Edl, Allm, Fazil, etc. ____

14. Area of specialized education
Write area for entries of specialized education in col. 13, e.g. Teaching, Engineering, Agriculture, etc. ____

Economic characteristics
(For persons 10 years of age and above)

15. Did he/she do any work at all last week for pay or profit (for a minimum of 15 hours, if worked as unpaid family helper) or there was a job but did not work).

[] 1 Yes
[] 2 No

For those who answered yes in Col. 15

16. What kind of work did he/she do most of the last week?

[Question 16 was asked of persons who had a job last week, per question 15.]
(Write title of occupation, e.g. Motor Mechanic, Carpenter, Taxi Driver, Cultivator, etc.
____

17. What kind of industry or business or service was he/she working in? ____

18. Did he/she work as

[] 1 Employer
[] 2 Employee
[] 3 Self employed
[] 4 Unpaid family helper

19. How many hours did he/she work during the last week? ____

For those who did not work for pay or profit last week
[Questions 20-21.]

20. Was he/she

[] 1 Able to work and looking for work (unemployed)
[] 2 Temporarily suspended for 30 days
[] 3 Job assured but not started
[] 4 Unable to work
[] 5 Others

(For those who answered yes to number 1 [able to work and looking for work] in column 20 only)
21. How long has he/she been looking for work?
Months _ _

Children born
(For ever married women only)

22. Age at first marriage
Write the age in completed years.

Give actual number, if none put a cross in the relevant column.
_ _

How many sons?

23. Were ever born to you? _ _
24. Are still alive? _ _

How many daughters

25. Were ever born to you? _ _
26. Are still alive? _ _

Period since last baby born alive?

Write (in years and months) the period from the date the last live baby was born to the date of enquiry.
27. Years _ _
28. Months _ _

Form 12

Area Code

1. Serial number of Household within Census Block (from Household Listing Register) ____

2. List all persons whether male or female, young or old at the place of usual residence. Do not list visitors except when they cannot be recorded at a usual residence.
Name ____

3. Relationship with Head of Household (List Head first) ____

4. Sex

[] 1 Male
[] 2 Female

5. Age

For those one year and above (in years)
For infants less than one year old (in months)
_ _

6. Marital status

[] 1 Never married
[] 2 Married
[] 3 Widowed
[] 4 Divorced

7. Religion

[] 1 Muslim
[] 2 Scheduled caste
[] 3 Caste Hindu
[] 4 Buddhist
[] 5 Christian
[] 6 Parsi
[] 7 Others

8. Mother tongue

[] 1 Bengali
[] 2 Urdu
[] 3 Punjabi
[] 4 Pushto
[] 5 Sindhi
[] 6 Baluchi
[] 7 Others
[] 8 Foreign nationals

9. Read and write with understanding

[] 1 Bengali only
[] 2 Urdu only
[] 3 Bengali and others
[] 4 Urdu and others
[] 5 Other languages only
[] 6 Illiterate

Male _ _
Female _ _
Total _ _