Person number 1 (The person named on the front side should be entered here)
[This form contains a question column, as well as columns for 4 persons. The questions below are for person number 1, and these are identical to questions for persons 2-4. The only difference is that the person who is providing the information should be entered as person number 1]
1. Last name, first name____
6. What type of income do you draw?
Persons that draw several types of income, state all
[] Income from employment
[] Apprentice's wages
[] Scholarship
[] Pension/retirement
[] Social welfare support
[] Half-orphan/orphan's social benefit
Which other types? ________
[] Without own income
6. What types of income do you have? (Persons with several types of income mark several):
[] Income from employment
[] Apprenticeship pay
[] Scholarship
[] Pension
[] Social assistance
[] Half or full orphan pension
[] Other types _____
[] Without own income