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Micro Enterprise Template 6 -Form Fill

Information
Q01

Name of the State

Q02

Name of the District

Q03

Name of the Block

Q04

Name of Panchayat

Q05

Name of the Village (PSU)

Q06

Type of Village

Q07

Micro-enterprise number

Q08

Name of micro-enterprise owner

Q09

Address of Household

Q10

Address of micro-enterprise

Q11

Type of user

Q12A

Interviewer’s Visits - 1

Q12A_1

Date

Q12A_2

Result

Q12B

Interviewer’s Visits - 2

Q12B_1

Date

Q12B_2

Result

Q12C

Interviewer’s Visits - 3

Q12C_1

Date

Q12C_2

Result

Enterprise PROFILE
A01

Name of the respondent/entrepreneur

A02

What is the sex of respondent?

A03

What is the religion of your respondent?

A04

Do you belong to a scheduled caste, scheduled tribe, other backward class or general class?

A05

Whether your enterprise is women owned enterprise?

A06

What is the date of formation of the enterprise?

A07

What is the category of enterprise?

A08

On an average, for how many hours do you run the enterprise in a day?

A09

Is this enterprise your primary source of income?

A10

How many people are engaged in your enterprise?

A11

In which months is the enterprise operational?

A12

How many other enterprises of similar nature are present in your village?

FUEL USE
B01

What is the average daily requirement of electricity in your enterprise? (in hours per day)

B02

What is the average daily supply of electricity in your enterprise? (in hours per day)

B03

Do you use the following appliances in your enterprise

B03_1

Bulb

B03_2

Fan

B03_3

T.V

B03_4

Rice Huller

B03_5

Flour Mill

B03_6

Chiller/Refrigerator

B03_7

Computer

B03_8

Photo copy machine

B03_9

Sewing Machine

B03_10

Oil expeller

B03_11

Cutting machines

B04

What is the main source of electricity that you use for operating this appliance?

B04_1

Bulb

B04_2

Fan

B04_3

T.V

B04_4

Rice Huller

B04_5

Flour Mill

B04_6

Chiller/Refrigerator

B04_7

Computer

B04_8

Photo copy machine

B04_9

Sewing Machine

B04_10

Oil expeller

B04_11

Cutting machines

B05

In case the main source fails, what do you use to operate the appliance?

B05_1

Bulb

B05_2

Fan

B05_3

T.V

B05_4

Rice Huller

B05_5

Flour Mill

B05_6

Chiller/Refrigerator

B05_7

Computer

B05_8

Photo copy machine

B05_9

Sewing Machine

B05_10

Oil expeller

B05_11

Cutting machines

B06

A. On an average, how many hours in a day is this appliance operated?

B06_1

Bulb

B06_2

Fan

B06_3

T.V

B06_4

Rice Huller

B06_5

Flour Mill

B06_6

Chiller/Refrigerator

B06_7

Computer

B06_8

Photo copy machine

B06_9

Sewing Machine

B06_10

Oil expeller

B06_11

Cutting machines

B07

What is the source of lighting in your enterprise?

B08

In case of non-availability of major source of electricity, what do you do?

B09

Do you face any of the following issues with respect to the electricity connection or the available source of energy?

B09_1

Light Fluctuation

B09_2

Low Voltage

B09_3

Disruption in Supply (Irregular Supply)

B09_4

Bad or poor supply during Rainy season or during bad weather

B09_5

Meter Availability (No meter is there and they want one)

B09_6

Difficult to contact in case of issues

COST OF PRODUCTION AND REVENUE
C01

What has been the initial investment in the enterprise?

C02

Did you take any loan for the enterprise?

C03

How much loan did you take for the enterprise?

C04

What was the source of the loan for the enterprise?

C05

What was the monthly rate of interest for the loan?

EXPENDITURE & REVENUE
D01

What is the average monthly expenditure for the enterprise on:

D01_1

Labour

D01_2

Rent for the enterprise

D01_3

Transportation cost

D01_4

Repairs and Maintenance

D01_5

Other Inputs/capital investment  (Purchase of something for the enterprise)

D02

On an average, how much do you spend on fuel and lighting for the enterprise in one month?

D02_1

Firewood (kg)

D02_2

Grid electricity ( unit)

D02_3

Kerosene

D02_4

LPG

D02_5

Coal

D02_6

petrol (litre) [including conveyance]

D02_7

diesel (litre) [including conveyance]

D02_8

Solar Power

D02_9

Mini-grid

D03

On an average, how much do you earn from this enterprise in a month?

D04

Of the total sales, how much do you earn from sale of your products to customers outside this village?

D05

What is the value of current unsold stock with you?

EXPANSION OF ENTERPRISE
E01

Is your enterprise able to fulfil the demands of its customers?

E02

Do you plan to expand your current enterprise?

E03

What are the reasons for not expanding?

E04

Have you received any skill development training for better development of your enterprise?

E05

What all trainings have you undergone?

E06

Do you require any training to develop your skills for running the enterprise?

E07

If yes, what kind of training do you require?

E08

Have you received any support in establishing backward linkages for running your enterprise?

E09

What kind of backward linkage support have you received for your enterprise?

E10

Do you require any support in establishing backward linkages for running your enterprise?

E11

What kind of backward linkage support do you require for your enterprise?

E12

Have you received any support in establishing forward linkage for running your enterprise?

E13

If, yes What kind of forward linkage support have you received?

E14

Do you require any support in establishing forward linkages for running your enterprise?

E15

What kind of forward linkage support do you require for your enterprise?

Satisfaction Level Test
F01

On a scale of 5, how satisfied are you with the following:

F01_1

Price of electricity

F01_2

Quality of light

F01_3

Regularity

NON-USERS OF MLINDA
G01

Are you aware of MLINDA connections available in your village?

G02

Did you ever avail an MLINDA connection?

G03

What package did you avail?

G04

Why did you discontinue with the connection?

G05

What are the reasons for not opting the connection under MLINDA?

G06

Would you like to have a connection under MLINDA?