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Note : 1.HH is the head of the house hold and in profession. The person could
be single or married. 2.If in a house hold there is more than one such person,
each such person will fill the form for inclusion in this publication. 3.On the
right side of the page a space will be provided for the single or joint
photograph of the HH with spouse. This photograph (two copies) will have to be
sent later on when asked at the time of the publication. 4.If for certain reason
you may not like to fill any of the item(s) of the form, please simply skip over
and go to the next item. 5.Confidential information like ones income, marital
status, place of marriage, last residence, last visit to India, date of parents
visit and members in family, will not figure on the page of the person in the
publication.Information on these items of the form is meant for demographic
purposes only.
First
Middle
Last
| Name(HH) | : |
| Address | : | |
| City | : | |
| State/Province | : | |
| Postal Code | : | |
| Country | ||
| Home Phone | : | |
| Mobile Phone | : | |
| E-mail Address | : | |
| Present Work Address | : | |
| Work Phone | : | |
| Work Fax | ||
| Income | : |
| Sex | Male Female |
| Age ( Yrs ) | Birth Date | DD | MM | YY | |
| Height(Cms) : | |||||
| Education : | |||||
| Marital Status: | Single Married Others specify |
Members of your family, with you in your country of
present residence
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