Questionnaire Text

Questionnaire form view entire document:  text  image

For persons 18 years and above
12. N.I.C. [National Identity Card]
[] 1 Yes
[] 2 No

Questionnaire instructions view entire document:  text  image
Column No.32: Inoculation of children
Are your children vaccinated? This question will be asked of the children of 10 years or below age. If answer is yes, then fill oval relevant to code 1, and if the answer is No, then fill the oval of code number 2.