Province _________
District _________
Administrative Post__________

Locality/Village _______
Neighborhood _______
Enumeration Area No. ____
Block No. ____
Name of City/Village _______
House No. _____
No. of dwellings in this household ____
No. of this household _____

Locality _______
Enumeration Area No. ____
Name of Village/Settlement _______
Name of Zone/Neighborhood _______
House No. _____
No. of dwellers in this house ____
No. of this household ____

Enumerator: Write the home address that can be used by the National Institute of Statistics (INE) to locate and identify the household.
Street: ________
No.:____ Floor:____ Apt:____
Description: ________