Questionnaire Text

Questionnaire form view entire document:  text  image
Birth date

_ _ 5. Month
_ _ 6. Year

7. Age at last birthday _ _

[] Lunar calendar (check if date of birth is stated in the lunar calendar)
[] Under one year
[] Aged 100 or over
Questionnaire instructions view entire document:  text  image
Columns 5and 6 - Date of birth

Ask the respondent to report day, month, and year of the birth of each individual according to their birth certificates or other official documents. If there is discrepancy between the actual date of birth and what is on the birth certificate, accept the latter.
? If the individual lacks birth certificate or other official document, accept the date that respondent gives. If the respondent is not informative, for individuals less than 100-year old [except the lunar hidjri calendar] enter MM in columns 5 and 6.
? For individuals 100-year or older, put X in the "100-year and older" box.
Colum 6 -Year
Follow the instruction below to fill this column:
? For individuals 100-year or older, independent of the type of calendar, whether or not the year of birth is clear, write X in the box "100-year or older" and leave both boxes in column clear.
? For individual is less than 100-year old:
[] For individual whose year of birth is based on lunar/ solar hidjri [Islamic] calendar, write the last two digits of the year of birth in the boxes in column 6, e.g. write 09 for 1309 and 25 for 1325.
[] For individuals with unclear year of birth write MM in both boxes.
[] If the year of birth is in Gregorian calendar turned it to the solar hidjri calendar before writing the last two digits in the corresponding boxes.
? If an individual's date of birth is not in any of the above calendars, do research and turn it into solar hidjri calendar, then document it.