Questionnaire Text

Questionnaire form view entire document: text image

4. Please provide the age and the month and year of birth

____ Age
____ Month of birth
____ Year of birth

Questionnaire instructions view entire document: text image

Part One. Personal Records

All persons should report R1 - R12.

R8. Birthplace
This should be the same as the permanent living place of a person's mother.
There are three standard answers for this question.

1. The same county/city/district
2. A different county/city/district in the same province
3. A different province

A person's birthplace is usually the same as their mother's permanent living place. In cases that a person's birthplace is a hospital, put their mother's permanent living place.