Serial No. _
Full name ________
Sex _
Age _ _
Relationship to head of household ____
Address on census night
____ Town/village
____ Region/country
How long absent? (in completed months) ____
Total number of persons on list C _ _
Lists of relationships to be specified
Head
Temporary head
Wife/husband
Son
Daughter
Father/mother
Father's brother/sister
Mother's brother/sister
Father's father/mother
Mother's father/mother
Brother
Sister
Brother's son/daughter
Sister's son/daughter
Son's son/daughter
Daughter's son/daughter
(Other specify)