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(for office use only)
Month
Sector
District
D.S.
Division
CONFIDENTIAL
P.S.U.No.
The information collected in this survey will be strictly confidential according to the survey ordinance and
individual level information will not
be divulged to any person or agency.
S.S.U. &
Household.No.
HOUSEHOLD INCOME AND EXPENDITURE SURVEY - 2005
NATIONAL HOUSEHOLD SAMPLE SURVEY PROGRAMME
SURVEY SCHEDULE
Department of Census & Statistics
Ministry of Finance and Planning
Sri Lanka
1
IDENTIFICATION INFORMATIONS
1. Address (Location) :......................................................................
Sector
District
.........................................................................
R
U
2. Province:........................................................................................
D.S.Division
E
3. District : ........................................................................................
(Select and circle the perticular number)
4. D.S.Division:.................................................................................
5. Name of MC/UC:-.........................................................................
(If Urban Sector)
Month of
Survey
P.S.U. No.
S.S.U
No.
Household
No.
6. G.N.Division : No......................... Name: ....................................
7. Name of Village :...........................................................................
(01-12)
(001 - 999)
(1 - 10)
(1 - 9)
(If Rural Sector)
Number of Households
8. Name of Estate: .............................................................................
(If Estate Sector)
9.
Result
C.B. No.:-............................... S.S.U. No......................................
10. Survey Month:-..............................................................................
11. Sample Stratum:-...............................................................
Name of the Head of the household -
..........
..................................
Interviewer's
Result Code
Completed...............................................1
Deferred..................................................2
No competent respondant at home.........3
Refused...................................................4
Household is temporarily closed...... ......5
Household is demolished/Vacant:.. ........6
Other (Specify)....... ................................9
1.
Housing units in D.S. Divisions unaffected by the Tsunami
2. (i) Housing units in unaffected census blocks in affected D.S.Divisions
(ii) Housing units in affected census blocks in affected D.S.Divisions
(iii) Families live in transist camps and transist houses.
Name
Signature:-
Date
Supervising Officer's
Name
Signature:-
Date
2
Code for Section - 1
Col 3 Relationship to head of the household
Head of the Household...............................1
Wife / Husband ..........................................2
Son/Daughter .............................................3
Parents .......................................................4
Other Relative ............................................5
Domestic Servants......................................6
Boarder.......................................................7
Other...........................................................9
Col. 7 - Religion
Buddhist . ....................................1
Hindu.. ........................................2
Islam ...........................................3
Roman Catholic/
Other Christian. ....................4
Other ...........................................9
Col. 8 Level of Education
Col. 4 Sex
Male ...........................
Female........................
1
2
Col. 6 - Ethnicity
Sinhala . ..............................1
Sri Lanka Tamil .. ...............2
Indian Tamil .......................3
Sri Lanka Moors ......... .......4
Malay ..... ...........................5
Burgher.. .............................6
Other ....... ...........................9
Studing Grade 1 ............................... 00
Passed Grade 1 .................................01
Passed Grade 2 .................................02
Passed Grade 3 ..................................03
Passed Grade 4...................................04
Passed Grade 5 ................................. 05
Passed Grade 6 ................................. 06
Passed Grade 7...................................07
Passed Grade 8.................................. 08
Passed Grade 9................................. 09
Pssed
Grade 10..................................10
Passed G.C.E.(O/L) or equivalent..........11
Pssed Grade 12 ............................... .12
Passed G.C.E. (A/L)/ or equivalent.... . 13
Passed G.A.Q./ G.S.Q.......................... .14
Passed Degree...................................... 15
Passed Post Graduate Degree/Diploma 16
No Schooling .......................................19
Col. 9 Marital Status
Never Married ...................
Married ..............................
Widowed ............................
Divorced .............................
Separated ............................
Col. 10 -
1
2
3
4
5
Usual Activity
Employed .......................... .........
Unemployed ........................... ..
Student .......................................
Household Work .........................
Unable/ To old to work ..............
Other ............................................
1
2
3
4
5
9
3
Agricultural
Activities
(Seasonal Crops)
Agricultural
activities
(Non seasonal
crops, livestock
fishing)
Non
agricultural
activities
11
*
*
Industry
10
Main
Occupation
(5 years and over)
9
*
Paid
Employment
8
Usual Activity
6
Level of Education
Religion
Ethnicity
4
Age as at last birthday
3
For persons 10 years and over
Did this person engage in any of the following
For Employed
activities during last month or last cultivation
persons only
year as employer, employee or
own account worker?
Marital status
2
Sex
1
Name of all persons who usually
live in this household
Relationship to head of
the household
Serial No.
SECTION 01 - DEMOGRAPHIC CHARACTERISTICS
13
14
15
16
12
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Names of the persons who are members of this
household & usually live elsewhere in the
2
country or abroad
42
43
44
45
Relationship Usually live in
to head of the 1. In the country
2. Abroad
4
household 3
Serial
No.
*
Main Occupation
(discribe)
**
Industry
(discribe)
4
Section 2 - Expenditure
2.1
Weekly consumption on Food and Drink
Item
Code
Unit
Qty,
1. Cereals
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
2
3
0101
0102
0103
0104
0105
0106
grams
grams
Consumed
Consumed
4
Item
Value
(Rs.)
5
1
Rice - (Kekulu)
Rice - (Samba)
Rice - (Nadu)
Rice - (Basmathi)
Rice flour
Wheet flour
Kurakkan flour
Maize
Samaposha
Noodles
Papadam
Infants cereal foods (Nestum)
Barley
Sago
Corn flakes
Other .........
0107
0108
0109
grams
grams
grams
grams
grams
grams
grams
grams
0110
0111 grams
0112 grams
0113 grams
0114 grams
0115 grams
0119
grams
9.
10.
11.
12.
13.
14.
15.
16.
2
3
Those/Itly
Rice (Meat & Vegetables)
Rice (Fish & Vegetables)
Rice (Vegetable only)
Curry (Meat)
Curry (Fish)
Curry (Vegetables)
Other .........
grams
number
number
number
number
number
number
0211 number
0212 number
0213
0214
0215
0219
03
1.
2.
3.
4.
5.
6.
7.
Dhal
Green Gram
Gram
Cowpea
Soya
Soya meat
Other ........
4. Vegetables
0201
0202
0203
0204
0205
0206
0207
0208
0209 number
0210 number
3. Pulses
02
Bread (Normal)
Bread (Special)
Rospaan
Buns/Spanchi
Hoppers
String Hoppers
Pittu
Rotti
Unit
01
2. Prepared foods
1.
2.
3.
4.
5.
6.
7.
8.
Code
1.
2.
3.
4.
5.
8
0301
0302
0303
grams
grmas
grams
grams
0304
0305 grams
0306 grams
0309 grams
04
Ash plantain
Brinjal
Ladies Fingers (Bandakka)
Bitter gourd
Long beans
Snake gourd
Ridge gourd
Sweet pumpkin
0401
grams
grams
grams
0402
0403
0404 grams
0405 grams
0406 grams
0407 grams
0408 grams
Qty.
4
Value
(Rs.)
5
5
Item
Code
9.
10.
11.
12.
13.
Beans
Carrot
Beet root
Cabbage
Tomatoes
0409
0410
0411
0412
0413
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Leeks
Knol khol
Capsicum
Dambala
Raddish
Drumstick
Cucumber
Kekiri
Ash pumpkin
Elabatu (Thalana batu)
Kohila yams
Lotus stemo
Plantain flower
Ambarella
Cadjunuts (raw)
Mashrooms
Jack immatured (Polos)
Other .........
0414
0415
0416
0417
0418
0419
0420
0421
0422
0423
0424
0425
0426
0427
0428
0429
0430
0439
Unit
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
Mukunuwenna
Gotukola
Kankun
Katurumurunga
Qty.
Item
Value
Code
(Rs.)
5.
6.
7.
8.
9.
10.
11.
5.
Nivithi
Thampala
Sarana
Kohila leaves
Onion leaves
Cabbage leaves
Other.......
Yams and other
0445
0446
0447
0448
0449
0450
0459
Unit
bundles
bundles
bundles
bundles
bundles
bundles
05
1.
Jak/jak seeds
0501
2.
Bread fruit
0502 number
3.
Potatoes
4.
Sweet potatoes
5.
Mannioc
0503 grams
0504 grams
0505 grams
6.
Kiriala
0506 grams
7.
Innala
0507 grams
8.
Other yams.........
0509 grams
6.
Meat
06
1.
Chicken
grams
grams
2.
Beef
0601
0602
0441 bundles
3.
Mutton
0603 grams
0442 bundles
0443 bundles
4.
Pork
5.
Sausages / Meetballs
0604 grams
0605 grams
0444 bundles
6.
Other ........
0609
Leafy Vegetables
1.
2.
3.
4.
Consumed
Consumed
grams
Qty.
Value
(Rs.)
6
Consumed
Item
7. Fish
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Sprats
Keeramin
Salaya
Hurulla
Seer
Katta
Unit
07
0701 grams
0702 grams
0703 grams
0704 grams
grams
0705
grams
0706
grams
0707
0708 grams
0709 grams
0710 grams
0711 grams
0712 grams
0713 grams
0714 grams
0715 grams
0716 grams
0717 grams
0718 grams
Balaya
Seer
Mora
Paraw
Thalapath
Kelawalla
Other large fish
Sprats
Hurulla
Karalla/Katuwalla
Kumbalawa/Angila
Salaya/Sudaya
Other small fish
Lula
Teppili/Telapiya/Korali
Other fresh water fish
Prawns
Crabs
Cuttle fish
Canned fish (Salmon)
8. Dried Fish
1.
2.
3.
4.
5.
6.
Code
0719 grams
0720 grams
Qty.
Consumed
Item
Value
(Rs.)
7.
Koduwa
8.
Anjila
9.
Balaya
10. Mora/Keelan
11. Paraw
12. Anguluwa
13. Prawns
14. Cuttle fish
15. Fresh water fish - dried
16. Jadi
17. Other......
0807
0808
0809
0810
0811
0812
0813
0814
0815
0816
0819
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
grams
0901 number
0909 number
Hen
Other...
10. Coconuts
1.
2.
Unit
09
9. Eggs
1.
2.
Code
10
1001 number
1002 grams
Nuts
Cocnut milk powder
11. Condiments
11
08
0801
0802
0803
0804
0805
0806
grams
grams
grams
grams
grams
grams
1.
2.
3.
4.
5.
6.
7.
Dried chillies
Chilly powder
Red onions
Bombey onions
Garlic
Maldive fish
Pepper
1101 grams
1102 grams
1103 grams
1104 grams
1105 grams
1106 grams
1107 grams
Qty.
Value
(Rs.)
7
Consumed
Item
Code
Unit
Qty.
Consumed
Item
Value
(Rs.)
Code Unit
13. Milk & Milk Foods
13
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Turmeric / Turmeric powder
Curry powder (sarakku)
Green chillies
Limes
Cumin seeds
Fennel seeds
Coriander
Mathe seeds
Mustard
Goraka
Tamarind
Cinnamon
Salt
Karapincha/ Rampe
Ginger
Vinegar
Other....
12. Other foods
1
2
3
4
5
6
7
Sauce
Marmite / Vegemite
Soup cubes
Lime pickle
Chutney
Canned fruits
Other....
1108
1109
1110
1111
1112
1113
1114
1115
1116
1117
1118
1119
1120
1121
1122
1123
1129
grams
grams
grams
number
1
2
3
4
5
6
7
8
9
10
11
1301
1302
Cow milk
Goat milk
Curd
Yoghurt / Moru
Condensed milk
Milk powder
Infant milk powder
Butter
Margarine
Cheese
Other...
ml
ml
1303
1304
1305 grams
1306 grams
1307 grams
1308 grams
1309 grams
1310 grams
1319
14. Fats & Oils
14
1
2
3
4
5
Coconut oil
Vegetable oil
Gingerley oil
Ghee
Other....
1401
ml
1402
1403
1404
1409
ml
ml
ml
ml
12
1201
1202
1203
1204
1205
1206
1209
15. Sugar / Juggery / Treacle 15
1
2
Sugar
Juggery
1501 grams
1502 grams
3
4
5
Treacle
Honey
Other....
1503
1504
1509
ml
Qty.
Value
(Rs.)
8
Consumed
Item
16. Fruits
1
2
3
4
5
6
7
8
9
10
11
Code
Unit
Banana
Pineapple
Papaw
Mangoes
Apple
Avacado
Wood apple
Oranges
King coconuts / Kurumba
Grapes
Other....
1601
1602
1603
1604
1605
1606
1607
1608
1609
1610
1619
number
number
number
number
number
number
number
number
number
grams
1651 grams
1652 grams
1653 grams
Dates
Cajunuts
Ground nuts
Plums
Other....
1654 grams
1659 grams
17. Confectionery & Short eats
17
1
2
3
4
5
6
Jam
Ice cream
Chocolates
Toffees
Biscuits
Jelly packets
Value
(Rs.)
Code
Unit
Qty.
16
Dried fruits
1
2
3
4
5
Qty.
Consumed
Item
1701
1702
1703
1704
1705
1706
grams
grams
number
grams
7
8
9
10
11
12
Snacks
Cake
Kewum/ Kokis etc.
Musket/ Kaludodol etc.
Thalabola/ Rulan etc.
Cutlets/ Patis / Wade /Pestry etc.
1707 grams
1708 grams
1709 number
1710 grams
13
Other.....
1719
18.Beverages (Non Alcoholic)
1
2
3
4
5
6
7
8
9
10
11
13
12
Tea Dust/ Leaves
Coffee powder/ Seeds
Soft drink
Fruit drink/ Cordial
Saruwath
Milk tea
Plain tea
Milk coffee
Coffee
Ice packets
Gruel
Bottled water
Other.....
1711
1712
number
number
18
1801 grams
1802 grams
1803
1804
1805
1806
1807
1808
1809
1810
1811
1812
1819
number
number
number
number
number
number
Value
(Rs.)
9
Consumed
Item
Code
19.
Unit
Liquor, Drugs and
Tobacco
19
1.
2.
3.
Toddy
Arrack
Kassippu
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Beer/Stout
Whiskey/Brandy
Gin
Wine
Other liquor
Drugs (Ganja,Haroin etc.)
Cigarettes
Cigars
Beedi
Other pipe tobacco
Betel leaves
Arecanuts
Tobacco chewing
Chunam
Bulathwita/Saravita
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1919
1920
1921
1922
1923
1924
number
number
number
number
number
number
Qty.
Value
(Rs.)
10
2.2
Household expenditure on Housing, Fuel and Light, Non-durable goods, Services and Consumer durables for main Household
∗ Main household
Code
Item
Unit
Qty.
∗ Main household
Item
Value
(Rs.)
Code
Qty.
2208
2209
Lipstick / Cutex
1. Housing (Average per month)
Shaving equipment
Rent (Estimated rent of owner occupied
house should be included in Col.5)
Taxes
Water bills
2001
Hair cut/ Hair dressing & shaving charges
2002
Other......
4.
21
3. Personalcareexpenses
(Lastmonth)
2219
Health expenses
(Last month)
23
2101
2102
Electricity
(Monthly average)
Kerosene oil (Monthly average)
Fire wood
(Monthly average)
Gas
(Monthly average)
Bulbes
(Last month)
Match box
(Last month)
Candles
(Last month)
Battery
(Last month)
Other ......
(Last month)
2103
ml.
kg.
kg.
2104
2105 number
2106 number
2107 number
2108 number
2109
Fees to private medical practitioners
(including cost of medicine)
Fees to Ayurvedic medical practitioners
Consultation fees to specialists
Payments to medical laboratories for
test analysis etc.
Payments to private hospitals and
2301
2302
2303
2304
2305
nursing homes.
22
Purchase of medical and pharmaceutical
Toilet soap
Tooth paste
Tooth brushes
Powder(Cosmetic powder)
Perfumes
Face cream / Lotions
Hair oils , cream & Hair dye
2210
2003
2. Fuel & Light (Average Per Month)
2201
2202
2203
2204
2205
2206
2207
Unit
2306
products.
2309
5. Transport (Last month)
Transport fees
Train/bus (other than schooling)
Van (other than schooling)
2401
2402
Taxi/three wheelers (other than schooling) 2403
∗ Main household - include all members of the household exclude servants and boarders.
Value
(Rs.)
∗ Main household
∗ Main household
Item
Code
Unit
Qty.
2404
Transport charges for schooling
Ships & air lines
Other....
2405
2409
Maintance of Private Vehicals
2411
Petrol & other fuel
Oil
Tyre, tube & spare parts
2412
Repair charges of spare parts
accessaries
2414
Licence & insurance
2415
2413
2419
Other.....
6. Communication ( Last month)
Telephone charges (Domestic/ Mobile)
(Avrege permonth)
2502
Telephone charges
(Taken from outside)
2503
2504
∗
2604
2605
2606
2607
2608
2609
Fees for professional & Technical education
Other.....
2619
8. Recreation, entertainment &
Cultural activities
(Last month)
Cinamas / Drama / Video films
Books/ News papers / Magazines
2701
2702
Lotteries/ Bettings
2703
Excursions/ Piligrimages
2704
2705
Arts/ Music/ Dancing
Sports
Beauty care/ Cookery/ Dress making
2706
Pets/ Aquarium
2707
2708
Toys
2709
2601
Maintanence of radio receivers,
television & Video decks
2710
2602
Other.....
2719
2509
Exercise book/ Stationeries
News papers/ Magazines
(Related to education)
2603
School text books
School facility fees (Government)
School fees (Private)
Tution fees
Boarding fees
Fees for higher education
(External Degree / Post graduate Degree
Diploma etc.)
27
2501
Telephone charges
( E-mail, internet)
Other.....
Code
26
Unit
Qty.
25
Postal & Tlegraph Charges
7. Education ( Last month)
Item
Value
(Rs.)
Main household - include all members of the household exclude servants & boarders.
Value
(Rs.)
12
∗ Main household
∗ Main household
Unit
Code
Item
Qty.
Item
Value
Code
Unit
28
3007 number
Banians
3008 number
3009 number
3010 number
3011 number
Women's under wears
Housecoats/Komonas/Night dresses
Brassieres
10. Household services
(Last month)
Skirts/Blouses
Men's under wears
2801
2802
2803
2804
2805
2806
2807
2809
Washing soap
Washingpowder
Mosquitocoils
Detergents
Insecticides (for home use)
Poslishes
Paints
Other....
29
Socks/Stockings
3012 number
3013 number
Ties
3014
number
Handkerchiefs
3015
Children's dresses
3016
number
number
School uniforms
3017
number
Towels
3018 number
Bed sheets
Pillow cases
3019
3020
Mosquito nets
3021
Other.....
3029
Laundry charges
2901
Grinding charges
2902
Wages to servants and chauffers
2903
Payments for other household services
2909
Materials purchase in meters
3001 number
For clothing
For school uniforms
Forcurtains/Furnishingmaterials
Other.....
11. Clothing and Textiles
(Last six months)
Trousers
Shirts
Tailoringcharges
T-shirts
3002 number
3003 number
3004 number
Sarongs/Vetties
Frock
3005 number
3006 number
For clothing
For schooling uniforms
Sarees
Value
(Rs.)
(Rs.)
9. Non-durablehouseholdgoods
(Last month)
Qty.
∗ Main household - include all members of the household exclude servants and boarders.
3041
3042
3043
3049
3061
3062
number
number
number
number
c. m.
c.m.
c.m.
c.m.
13
∗ Main household
∗ Main household
Item
Code
Unit
Qty.
Item
Value
(Rs.)
Code
Unit
Qty.
12. Footwear & other personal effects
(Last 6 months)
31
Shoes
3101 number
Sandals / Slippers
3102 number
Umbrellas
3103 number
Hand bags/ Travelling bags
3104 number
Hats/ Helmets
3105 number
3106 number
Rain coats
3208 number
3209 number
3210 number
3211 number
Brooms/ Brushes/ Ekels
Mats/ Pillows
Rugs/Carpets
Mettress
Torches
Thermos flasks
Twines/ Ropes
Other......
3212 number
3213 number
3214 number
3219 number
Repair charges for shoes, bags, umbrellas
3107
etc.
Other....
3109 number
14. Durable household goods
(Last 12 months)
33
13. Durable household goods
(Last 6 months)
32
Glass ware
3201 number
Plastic ware
3202 number
Aluminium ware
3203 number
Clary ware/ Pots
3204 number
Cane ware
3205 number
Cutlery
3206 number
Lamp/ Lamp shades
3207 number
∗
Chairs (Plastic / Wood)
Tables
Settees
Almyrahs
Beds
Otherfurniture
Clocks/ Wrist watches
Cookers (Kerosene/ gas/ Eletric)
Mixing machines, Grinders, Beaters
Irons
Refrigerators
Fans
Sewing machines
Main household - include all members of the household exclude servants & boarders
3301 number
3302 number
3303 number
3304 number
3305 number
3306 number
3307 number
3308
3309
3310
3311
number
number
number
number
3312 number
3313 number
Value
(Rs.)
14
∗ Main household
Item
Code
Unit
Qty.
∗
Item
Value
Code Unit
(Rs.)
Radio, Record players and Tape recorders
3314 number
15.
3315 number
Television and Vedio decks
Washingmachines
Musicalinstruments
Bicycles
Motorcycles/Scooters
Other expenses
(Last month)
34
3316 number
3317 number
3401
Provident funds, W.& O.P.fund
3318 number
Contribution to trade unions,
3319 number
Motorcars/Vans
Prams/Gocarts/Tricycles
Garderning tools and equipments
Thrift societies etc.
3320 number
3321 number
3402
Insurance / Agrahara
3403
3322 number
3323 number
Other savings (including seettu)
Payments of debits
3404
3405
3324 number
Income tax
3406
Jewelleries
Telephones / Cellular phones
Other kitchen appliances
(Heaters, Rice cookers etc.)
3325 number
Other...
3409
Other...
3329 number
Durable goods purchased in instalments .
3339
Cameras and Projectors
Computers
3326 number
3327 number
16.
Other adhoe (rarely) expenses
(Last 12 months)
Expenditure on weddings/ Funerals for family
∗
members
3501
Social activities/ Ceremonies
3502
Litigation
3503
Gift, Donation, Similar tranfers
3504
Maintance/ Repairing
3505
Purchased properties, houses
3506
Loans givien
3507
Other...
3509
Main household - include all members of the household exclude servants and boarders.
Main household
Qty.
Value
(Rs).
15
2.3
Expenditure on Housing, Fuel and Light, Non durable goods, Services and Consumer durables for Boarders and Domestic Servants.
Clothing and textiles
(Last six months)
Non durable household
goods
(Last month)
Household services
(Last month)
Personal care and Health
expenses
(Last month)
Transport and
Communications
(Last month)
Recreation,Entertainments
Education, Cultural activities etc. (Last month)
Miscellaneous
(Last month)
Durable household goods
(Last 12 months)
Boarding, fee paid
(Last month)
Amount sent to family/
parents (Last month)
Amount transfered as savings,
provident funds, W&OP taxes,
donations
etc. (Last month)
Go to section 3
Fuel and light
(Last month)
1
2
Food purchased outside the
household (Last week)
Name of boarders and Domestic
Servants who has spent money
on any of the following column 3-15
No
Serial number as given in column
1 of section 1
Are there Boarders and/or Domestic Servants in this household Yes 1
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
(Rs.)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1.
2.
3.
4.
5
6
7
If any of the items in column 3-15, have been received free of charge, their estimated value should also be included as an expenditure.
If any boarder or domestic servant given in column 1 of section 1, not spent any of the above. Please note down here.
16
Section 3 - Income
3.1 Income from paid employment/s during last four weeks/last calendar month
Main
- 1
Secondary - 2
(Rs.)
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Bonus, Arrears
payment
Principal/Secondary
occupation
(discribe the occupation)
Last12months
Tips, Commissions,
Allowances, Overtime pay etc.
Duringlastcalendarmonth
Salaries/ Wages
List all the household members (usually live in
this household) including boarders and domestic servants who were paid employees during
last four weeks/ Last calendar month.
Serial number as given in
column 1 of section 1
If any of the household members (usually live ) engage as an employee during last 4 weeks / Last calender month. Fill in the relevant columns.
(Rs.)
(Rs.)
17
3.2 Income from Agricultural activities - Paddy, Other seasonal crops and Tobacco
**
(If any of the household members cultivate paddy, other seasonal crops and tobacco as an employer or own account worker for sale and/or household consumption
during last cultivation year. Fill in the relevant columns)
**
Code
(for office use only
List all the household members (usually live)
including boarders and domestic servants who have
any cultivated paddy and/ or other seasonal crops as
employers or own accounts workers.
Serial
number
as given
in
Paddy Other seasonal
column
crops and Tobacco
1 of
section 1
Cultivated
land area
A
Codes for column 3
** Last cultivation year
Paddy................................... 1
Chillies................................ 2
Onions................................. 3
Vegetables ..........................4
Cereal items........................ 5
Yams...................................6
Tobacco...............................7
Other................................... 9
R
*
Hired Labour
Last two cultivation season
Seeds
(Yala/Maha or Maha/Yala)
Fertilizer
Chemicals
Transpor charges
Other...
Total
P
Lastcultivationyear
Value of
out put
Value of amount
consumed by this
household
(Rs.)
(Rs.)
* Cost
(Rs.)
18
3.3 Income from other agricultural activities
If any of the household members engage in any other agricultural activities / Livestock as an employer or own account workers for sale during last 12 months.
Fill in the relevent columns.
Agricultural product
(Describe)
A
+ Codes for column 3........
Tea, Rubber..... .......................01
Coconuts ................................02
Coffe, Pepper, Betel etc..........03
Banana/ Fruits.........................04
Meat........................................05
Fish ........................................06
Eggs. ......................................07
Milk........................................08
Other food items.. ..................09
Fire wood ...............................10
Other.......................................19
R
*
Hired Labour
Seeds
Fertilizer
Chemicals
Transports/ Tractor charges
Other
Not necessary for cultivated area under the codes from 05-10 in column 4
Value of
out put
(Rs.)
Cultivated area
+
Serial
number
as given
in
column 1
of
section 1
Code
Lastmonth/Averagepermonth
List all household members (usually live)
including boarders & domestic servants who have
engaged any other agricultural activities/
Livestock as employers or own accounts
workers.
Total
P
Value of amount
consumed by this
household
(Rs.)
*
Cost
(Rs.)
19
3.4 Income from Non-agricultural activities during last calendar month
List all the household members(usually live)
including boarders domestic servants who
have engaged Non- agricultural activities as
employers or own account workers.
1
Serial
number
as given
in column
1 of
section 1
Economic activity
(Describe)
2
3
1.
2.
3.
4
5
6
7
8
9
10
Code for column 3
Mining and Quarrying................................1
Manufacturing............................................2
Construction...............................................3
Trade..........................................................4
Transport....................................................5
Guest house, restaurants, bars, hotels etc..6
Other services............................................7
*
Hired Labour
Inputs
Transport
Other...
Total
Code
(for office use only
(If any of the household members engage in any non - agricultural activities as an employer or own account worker for sale during last cultivation year. Fill in the
relevant columns)
4
Lastcalendarmonth
Value of
out put
* Cost
(Rs.)
(Rs.)
5
6
20
3.5.1
Income from Other cash receipt during last calendar month/ Last 12 months
List all the household members (usually live) including boarders and servants who have received
any other cash receipt.
Serial number as
given column 1 of
section 1
Income in last month
During last 12 months
Current remittance and
transfers
Pension
payment
(Rs.)
Disability and
relief payments
(Rs.)
Rents from Samurdhi/ Dividends
properties/
interests etc.
Food
Boarding fees stamps
etc.
(Rs.)
(Rs.)
(Rs.)
Other Income from Within the
abroad
Income
country
(Rs.)
(Rs.)
(Rs.)
List all the household members (usually live) excluding boarders and servants who have received
any income by chance or rarely.
Serial number as
given column 1 of
section 1
3.5.2 Income by chance or adhoc gains during last 12 months
Sales of assests
Loans taken
(Land , house,
from banks/
jewellery)
Money lenders
etc.
(Rs.)
(Rs.)
Withdrawal from Lottery/ Any
adhoc gains
savings & bank
deposits.
(Rs.)
(Rs.)
Seettu/
Repayments Compansation
of loans
givien
(Rs.)
(Rs.)
Other
(Specify)
(Rs.)
3.6 Income in kind during last calendar month
21
(If any of the household members receive any of the following items as a payment or fringe benefit/donation/gift from the employer or other during relevant
period. Fill in the relevant columns)
List all the household members including boarders domestic servants who
have received income in kind.
3.7
Serial
number
as given
in
column
1 of
section 1
From employers/
Others.
Meals, Food
items etc.
Housing
Clothing
Medical
facilities
(Last week)
(Last month)
(Last 6 months)
(Last month)
(Rs.)
Employer
1
Other
2
Employer
1
Other
2
Employer
1
Other
2
Employer
1
Other
2
Employer
1
Other
2
Employer
1
Other
2
Employer
1
Other
2
(Rs.)
(Rs.)
(Rs.)
Warrants/
Passes etc.
(last month)
(Including free
transport)
(Rs.)
Other
(Last month)
(Rs.)
Monthly rental value of owner occupied house
Q.
Did the household occupy its own house last calendar month.
Yes
1
No
2
→
What is the estimated gross rental value per month
Rs.
Please Note:- If items like cloths, warrants etc. have been received relief payments, their estimated value should be filled under the head of the household.