Questionnaire Text

Questionnaire form view entire document:  text  image
Chapter H.

For women 12 years of age and older

35. What was the date of the birth of your last son or daughter born alive?

____ Day
____ Month
____ Year
Questionnaire instructions view entire document:  text  image
H. Population information
For women twelve years old and older.

Question 31, 32, 33, 34, 35: Fertility, infant-juvenile mortality

35. On what date was your last son (or daughter) born alive?

You should Arabic numerals to write the day, the month of birth and write the year with four digits.

Example: Day [12] Month [05] Year [1979]