Questionnaire Text

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24. How many persons who were members of this household have died in the past twelve months? (Write this in the table) (basic) _ _
If the answer is 00, continue with Control 7.


[Details on the first person who died]

Sex
[] 1 Man
[] 2 Woman


Age at time of death _ _ _

Is there a death certificate?
[] 1 Yes
[] 2 No


[There is space for 5 people.]

(If you encounter a household where there are more than five persons who have died in the past twelve months, use as many additional forms as necessary.)