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[p. 1]

Republic of Togo
General Population Census

Town ____

Date: ____
Census agent: _
Circle of subdivision: _ _
Circumscription: _
Block: _ _
Compound: _ _ _ _
Dwelling: _ _

Collective sheet


Street ________
Number ____
Neighborhood or place name ____

Persons to register on this sheet
All members of the family or household should be registered if:
- Present and temporarily absent: all members of the family normally residing in the dwelling including those who are temporarily absent during the census (period of absence specified lower than 6 months): hospital patients, fishers at sea, business travel and so on)...

Also, all members of the family or household should be registered if are: domestic employees, apprentices, wage earners, boarders or sub-leasers lodging with the family.

If the sub-leasers occupy one or several independent rooms they will be considered as being apart and will be the subject of a separate sheet.

- Occasional visitors: persons not normally residing in a permanent fashion in the dwelling but present at the time of the census and having spent at least one night in the dwelling surveyed.

The following persons should not be registered on this sheet
- Those absent for a long period (more than 6 months)

Patients in hospitals
Soldiers carrying out their military service
Students living in boarding schools
Fellows abroad
Children placed in an apprenticeship and enumerated with their lodger
Detainees in prisons or detention centers
Insane persons residing in an asylum

Those persons should not be registered, whatever the place where they are located.

Individual information appearing on the census questionnaires is strictly confidential. The census agents should not communicate it to anybody apart from the members of the census committee.

It will only be used for the drawing up of anonymous statistical tables and electoral lists: in particular, it can in no case be used for tax purposes.

The census determines the number of inhabitants of the municipality, the division of the populate by age, profession and so on, the division of families according to the number of children, the composition and equipment of properties and dwellings and so on, information which is indispensable for the study of any social, economic or demographic problem.

Also, we appeal to the good will of all to facilitate our work, by giving accurate, detailed and complete information.

[p. 2]

1. Order number _ _

2. Surname and first names
Order of registration to follow:

[] Head of the household
[] Unmarried children of the head whose mother does not live with him/her
[] His/her spouse
[] Unmarried children of the spouse beginning with the youngest
[] Possibly other spouses and their children
[] Married children followed by their spouse and their children
[] Parents and grandparents, brothers, sisters, uncles, aunts and so on by decreasing link of parentage
[] Other persons (friends, boarders and so on)

3. Relationship to head of the household

[] Head of family
[] Spouse (followed by number indicating their rank)
[] Son or daughter (followed by an order number of the father and the mother)
[] Others (to be indicated clearly)

4. Parentage

Record here:

The name of the father and mother
The names of deceased persons should be preceded by a cross (+)
If the father or the mother appears on this sheet, record their order number

____ Father
____ Mother

5. Sex

[] Male
[] Female

6. Marital status

[] Unmarried
[] Married followed by the number of wives or rank of spouse
[] Widower
[] Divorced
[] Free union

7. Age

Years _ _ _
Months _ _

8. Place of birth

[] T (for those born in Togo according to the name of the subdivision) ____
[] F (for French people according to the name of department) ____
[] For others indicate the country or territory ____

9. Nationality or ethnic group ____

For residents of Togo indicate ethnic group
For foreign people, record their nationality: English, Lebanese, Ghanaian and so on

10. Number of children

(This question must be asked to women only)

Alive children
_ Male
_ Female
Total children ever born
_ Male
_ Female

11. Level of education

[] Elementary certificate
[] Certificate of education

For those who know how to read and write a language record this language, for example:
[] German
[] French
[] English
[] None

Social situation

12. Trade or main occupation ____

a) For civil servants record "F" followed by grade
b) For private and semi-public workers specify as much as possible. E.g.: cashier, accountant, mechanic, transport entrepreneur, wine wholesaler, mason
For employees precede with an "S"
c) For children attending school record E followed by the institution they attend. E.g. (E - middle school)
d) For those without profession record "SP"

13. Employment

[] Permanent
[] Temporary
[] Seasonal
[] Unemployed
[] Without profession

14. Residence in the municipality

[] Present
[] Absent
[] Seasonal
[] Other

Length of residence

[] Years _ _
[] Months _ _

[p. 3]

Information on the dwelling
(Circle the box corresponding to the correct response)

1. Nature of the construction of which the dwelling forms part

[] 1 Building of European type with or without floors
[] 2 Individual house or villa
[] 3 African hut in stone/brick or adobe
[] 4 Other African hut (thatched, wood, sheet iron and so on)
[] 5 Other (specify) ____

2. Supply of the dwelling:

Water supply

[] 1 By piping, in dwelling
[] 2 By piping, in compound
[] 3 By piping, outside compound
[] 4 By well, in compound
[] 5 By well, outside compound

Electric lighting

[] 1 Yes
[] 2 No

Waste disposal

[] 1 Septic pit
[] 2 Buckets
[] 3 Other

3. Number of habitable rooms _ _

4. Number of persons in the dwelling to be counted in the census:

_ _a. Number of persons who usually live in the dwelling (present and absent temporarily)
_ _ b. Number of persons present occasionally (travelling, visiting, present for a short period)