Write "unique", when there is only one family; 1st, 2nd, 3rd, etc, when there are more than one families.

[The following questions are organized into a table. Each question appears in a column, in the order depicted below from left to right, and there 15 rows for each person's answer.]

Reference Number [pre-printed two digit number, 01 through 15]

Reference person's complete name: ____

First and last name to all other persons.
Example: Maria Fernanda Silva

Relationship to household's reference person ____

Family relationship with the head of the household: (you should mention, in the column right next to the name, what is the relationship with the head of the household according to the following list):

[] Representative of the family [Head of the household; pre-filled for person 01]
[] Husband
[] Wife
[] Single son/daughter
[] Non-single son/daughter
[] Daughter-in-law
[] Son-in-law
[] Father
[] Mother
[] Grandchild
[] Great-grandchild
[] Other Relative
[] Not related

Indicate the spouse/partner's reference number: _ _

For married people who live together in the same dwelling

Indicate the reference number of [your parents]:

For single people who live in the same dwelling as parents, father or mother.

_ _ Father
_ _ Mother