Questionnaire Text

Questionnaire form view entire document:  text  image
18. Born in Malaysia?

[] Yes
[] No (Skip to 20)
[] Unknown (Skip to 22)

19. State of birth?

[Question 19 was asked if the person was born in Malaysia.]

[] Johore
[] Kedah
[] Kelantan
[] Malacca
[] N.Sembilan
[] Pahang
[] Penang
[] Perak
[] Perlis
[] Selangor
[] Trengg.
[] Sabah
[] Sarawak
[] Unknown

20. Country of birth?

[Question 20 was asked if the person was not born in Malaysia.]

[] Singapore
[] Thailand
[] India/Ceylon Pakistan
[] Indonesia
[] N. Sembilan
[] Philippines
[] China
[] Other Asian
[] n/s America Oceania
[] Europe
[] Other