Statistical Office of the Slovak Republic
Population and Housing Census 2001

Personal form

Registered by the SOSR no. VK 1/01 1.6.2000
Individual data protection is guaranteed by the Act of Slovak National Council No. 322 1992 of the Code in the notion of further regulations. Personal data protection is guaranteed by the Act No. 52/1998 of the Code. The Statistical Office of the Slovak Republic is responsible for individual and personal data protection.

Foreigner living on the territory of the Slovak Republic less than 30 days has to fill in only questions 3, 4, 9, 22, and 23.

Patterns of filling in the form:

Fill in the form with black or blue ink. Write letters in capital.

1. Type of residence

[] Permanent - present
[] Permanent - temporarily absent
[] Temporary [Temporarily present persons have to fill in also questions 22 and 23 (address, name, and surname)]

2. Relationship to the user of dwelling

[] User of dwelling
[] Husband, wife
[] Mate
[] Son, daughter, son-in-law, daughter-in-law
[] Grandchild, great-grandchild
[] Parent, grandparent, parent-in-law
[] Other relative
[] Lodger
[] Other person

3. Date of birth

Day _ _
Month _ _
Year _ _ _ _

4. Sex

[] Male
[] Female

5. Marital status

[] Single [continue with question 8]
[] Married [continue with questions 6 and 7]
[] Divorced [continue with questions 6 and 7]
[] Widowed [continue with questions 6 and 7]

6. Date of marriage (write the date of current or last marriage)

Month _ _
Year _ _ _ _

7. Order of marriage (write the order of current or last one) ____

8. Number of live-born children (to be filled in only by women) _ _

9. Citizenship

[] Slovak Republic
[] Without citizenship
[] Other ____

10. Nationality

[] Slovak
[] Czech
[] Hungarian
[] Ruthenian
[] Romany
[] Ukrainian
[] Other: ____

11. Mother language (in the case of different languages of parents, write down the mother's one)

[] Slovak
[] Czech
[] Hungarian
[] Ruthenian
[] Romany
[] Ukrainian
[] Other: ____

12. Religion/church

[] Roman-Catholic
[] Evangelic church of Augsburg affiliation
[] Greek-Catholic
[] Reformed Christian Church
[] Orthodox Church
[] Religious Community of Jehovah Witnesses
[] Evangelic Methodist Church
[] Brethren Baptist Union
[] Brethren Church
[] Seventh Day Adventists' Church
[] Apostle Church
[] Jewish Religious Communities
[] Old-Catholic Church
[] Christian Corpses
[] Czechoslovak Hussite Church
[] Without religious affiliation
[] Other: ____

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13. Educational attainment - name of the school

[] Elementary
[] Apprentice (without leaving exam)
[] Vocational (without leaving exam)
[] Vocational complete (with leaving exam)
[] Secondary
[] Higher (enterprise institutes, trainings at universities)
[] University bachelor
[] University master, engineer, doctor
[] University doctorand
[] Without educational attainment (born 25.5.85 and older)
[] Children up to 16
Name of the school (by universities also faculty) ____

14. Economic activity

[] Working (except of pensioners)
[] Apprentice
[] Secondary school student
[] University student
[] Person on maternity leave (includes further maternity leave)
[] Homekeeping
[] Pensioner
[] Unemployed
[] Child up to 16
[] Other

15. Social group

Employee working for wage, salary, other kind of remuneration

[] In a state enterprise (budgetary organization or contribution organization, state share company or other organization owned by the state)
[] In a private enterprise (at company, at tradesman)
[] In an agricultural cooperative or other cooperative organization
[] At other employer

[] Member of production cooperative
[] Entrepreneur (partner, tradesman) with employees
[] Entrepreneur (partner, tradesman, own account agricultural worker, liberal profession) without employees
[] Helping (non-paid) household member in family enterprise
[] Other non-specified

16. Periodicity of journey to work or to school

[] Daily
[] Other than daily
[] None

17. Time spent by daily journey to work or to school in minutes _ _ _

18. Occupation (Write down the work or function) ____

19. Name and address of employer or school (part of town in Bratislava and Kosice)

____ Name
____ Part of town
____ Municipality
____ District

20. Place of work (part of town in Bratislava and Kosice)

____ Street
____ Part of town
____ Municipality
____ District
____ Orient. number of house

21. First permanent residence (permanent residence of mother in time of birth of enumerated person)

____ Municipality
____ District
____ Country

22. Address of permanent residence (To be filled in only by persons with temporary residence and foreigners. Fill in also question 23.)

____ Street
____ Part of town
____ Municipality
____ District
____ Reg. number of house
____ Orient. number of house

23. Name and surname

____ Name
____ Surname

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House form

Individual data protection is guaranteed by the Act of Slovak National Council No. 322 1992 of the Code in the notion of further regulations. The Statistical Office of the Slovak Republic is responsible for individual data protection.
Patterns of filling in the form

Fill in the form with black or blue ink. Write letters in capital.

1. Type of house

[] Family house
[] Dwelling house
[] College, hostel
[] Social care institutions
[] Pensioners' home
[] Church institution
[] Other: ____

2. Occupancy of the house

[] Permanently occupied
[] Accommodation institution without dwelling
[] Vacant due to change of owner
[] Vacant - designed for recreation
[] Vacant for rebuilding
[] Vacant - non-suitable for habitation
[] Vacant after approval
[] Vacant at survival or legal proceedings
[] Vacant for other reasons

3. Type of ownership

[] Physical person
[] State
[] Dwelling cooperative
[] Fund of National Property of Slovak Republic
[] Commercial company
[] Other corporate body
[] Church property
[] Foreign owner
[] Ownership combination
[] Other ownership

4. Number of flats _ _ _

5. Number of storeys (floors) _ _

6. Period of construction (rebuilding)

[] Up to 1899
[] 1900-1919
[] 1920-1945
[] 1946-1960
[] 1961-1970
[] 1971-1980
[] 1981-1985
[] 1986-1990
[] 1991-1995
[] 1996-1999
[] 2000 and later

Technical equipment of the house

7. Construction material of supporting walls

[] Bricks
[] Stone and bricks
[] Non-fired bricks
[] Stone
[] Wall panels
[] Wood
[] Skeleton
[] Other

8. Elevator in the house

[] Yes
[] No

9. Piped water

[] Installed in house from public supply system
[] Installed in house from private supply system
[] Outside the house from public supply system
[] Outside the house from private supply system
[] None

10. Sewage

[] Connection to public sewage system
[] Private sewage disposal plant
[] Without sewage

11. Piped gas

[] Yes
[] No

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Dwelling form

Fill in the form with black or blue ink. Write letters in capital.

1. Occupancy of dwelling

[] Permanently occupied
[] Habitation outside the dwelling
[] Vacant due to change of the user
[] Vacant - designed for recreation
[] Vacant for rebuilding
[] Vacant - non-suitable for habitation
[] Vacant after approval
[] Vacant at survival or legal proceedings
[] Vacant for other reasons

2. Tenure status

[] Dwelling in own (family) house
[] Property of person in dwelling house
[] Other free of charge tenure
[] Rented dwelling
[] Dwelling of cooperative
[] Provided in return for services
[] Other

3. Period of construction

[] Up to 1899
[] 1900-1919
[] 1920-1945
[] 1946-1960
[] 1961-1970
[] 1971-1980
[] 1981-1985
[] 1986-1990
[] 1991-1995
[] 1996-1999
[] 2000 and later

4. Size of dwelling (round off to integer)

Useful floor space in square meters _ _ _
Living floor space in square meters _ _ _
Floor space of kitchen in square meters _ _ _
Number of rooms _ _

5. Position of dwelling

[] Ground floor
[] Ground floor and first floor
[] First floor
[] Second floor
[] Third floor
[] Fourth through sixth floor
[] Seventh floor and higher
[] Basement

Technical equipment of the dwelling

6. Piped water

[] In dwelling
[] Outside the dwelling
[] None

7. Source of hot water

[] Outside the dwelling
[] Own central heating
[] Electric pre-heater or flow heater
[] Gas pre-heater or flow heater
[] Other
[] Without hot water

8. Piped gas

[] From the public supply system
[] None

9. Prevalent type of heating

[] Central long-distance heating
[] Central local heating
[] Storey heating
[] Stove
[] Other

10. Prevalent heating medium

[] Gas
[] Electricity
[] Liquid fuel (petroleum, oil)
[] Solid fuel (coke, coal, wood)

11. Bathroom or shower

[] Yes
[] No

12. Flush toilet

[] Yes
[] No

Household equipment with durable consumer goods

13. Individual refrigerator

[] Yes
[] No

14. Refrigerator with freezer

[] Yes
[] No

15. Individual freezer

[] Yes
[] No

16. Automatic washing machine

[] Yes
[] No

17. Color TV

[] Yes
[] No

18. Telephone in dwelling

[] Yes
[] No

19. Mobile telephone

[] Yes
[] No

20. Recreation hut, cottage

[] Yes
[] No

21. Car

[] Yes
[] No

22. Personal computer

[] Yes
[] No

23. Personal computer with Internet

[] Yes
[] No

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Table A contains all persons enumerated in a dwelling, i.e. persons for whom the Personal Form was filled in. In first positions permanently resident persons are to be written (including permanently living persons but temporarily absent) then persons temporarily present at the decisive moment. Column b contains name and surname of all persons present in a dwelling. Column c contains the relationship to the user of dwelling. Column d contains the code of the relationship to the user of dwelling.

If there are more than 10 persons in the dwelling, please continue on the next form Envelope of the Personal Form which will be given to you by the enumerator.

A. Summary of persons in dwelling

No. _ _
Name and surname ____
Relationship to the user of dwelling ____
Code of relationship:

[] 01 - User
[] 02 - Husband, wife
[] 03 - Mate
[] 04 - Son, daughter
[] 05 - Son-in-law, daughter-in-law
[] 06 - Grandchild, great-grandchild
[] 07 - Parent, grandparent, parent-in-law
[] 08 - Other relative
[] 09 - Lodger
[] 10 - Other person

To be filled in by enumerator

B. Housekeeping units - HU

No. of HU _
Relationship to the reference person:

[] 1 - Reference person
[] 2 - Husband, wife
[] 3 - Mate
[] 4 - Son, daughter
[] 5 - Son-in-law, daughter-in-law
[] 6 - Grandchild, great-grandchild
[] 7 - Parent, grandparent, parent-in-law
[] 8 - Other relative
[] 9 - Other person
[] 0 - Person out of the household

C. Private household - PH

No. of PH _
Relationship to the reference person:

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