Questionnaire Text

Questionnaire form view entire document:  text  image

Q06: Date of birth or age
(Specify the date of birth or the age, depending on declaration)

- Date of birth:
(Example: a persons declares being born on February 4, 1967, write down 4 February 1967, in write in the appropriate boxes: 0 2 / 1 9 6 7
MM in months _ _
YYYY in years _ _ _ _


- Age:
(Example: a persons declares being 47 years of age, write down 47 boxes: 4 7
(For children younger that 1 year of age, write "00")

_ _
Questionnaire instructions view entire document:  text  image
6. Date of birth or age

Show clearly date of birth or age according to declaration.

a. Date of birth example: Declared 9 July 1953, write "07" "1953"

b. Age in years example: Declared [to be] 48 years old. Put "48".

For [persons] younger than 1 year, write "00".