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Demographic Profile -Form Fill
Q1
Name of the Selected Respondent
Q2
What is your current marital status?
Never married/Single
Currently married, living with spouse
Currently married, not living with spouse
Divorced/Separated
Widowed
Not married but living with partner
In a marriage where the husband has more than one wife
Married, gauna not performed
Don’t know
Refused
Others (Specify)
Q3
How old are you?
Q4
How old is your wife?
Q5
What was your age at the time of your marriage?
Q6
Did you start living with your spouse immediately after marriage?
Yes
No
Q7
If no, why so?
We were very young
My spouse was less than 18 years of age
Custom of Gauna being performed
Financial constraint
Wanted to complete school education
I work/ stay somewhere else
My wife did not know household chores, so she didn’t come
Other, Please Specify
Q8
How old were you when your wife started living with you?
Q9
Are you presently living with your wife?
Living with spouse
Spouse staying elsewhere
Q10
At present, with whom do you live?
Living alone
Living away from wife at my mother’s place
Living away from wife, she lives with my mother
Living away from wife, at other’s (elder/ younger brother’s family)place
Living with wife only, nuclear family set up
Living with wife& Mother
Living with my wife at her mother’s place
Living with others (elder/ younger brother’s family) along with wife
Q11
Typically in a year, how many months do you stay with your spouse?
Less than a month
1-2 months
3-5 months
6 months
More than 6 months
Other (specify)
Q12
Have you ever attended school?
Yes
No
Refused
Q13
What is your highest level of educational attainment?
Illiterate
Literate with no formal education
Did not complete primary education
Primary school (up to Class V)
Middle school (up to Class VIII)
Secondary school (up to Class X)
Senior/higher secondary school (up to Class XII)
Diploma
Graduate/college and above
Post graduate/University
DK/CS
Refused
Q14
What is your wife’s highest level of educational attainment?
Illiterate
Literate with no formal education
Did not complete primary education
Primary school (up to Class V)
Middle school (up to Class VIII)
Secondary school (up to Class X)
Senior/higher secondary school (up to Class XII)
Diploma
Graduate/college and above
Post graduate/University
DK/CS
Refused
Q15
How easy is it for you to read a paper written in?
Cannot read at all
Able to read only part of sentence
Able to read whole sentence
Q16
What is your occupation?
Agricultural labourer
Other Labourer
Farmer
Artisan
Petty trader/shop owner
Petty trader/shop owner
Unskilled worker
Skilled worker
Self employed
Clerical/supervisory/sales person
Government Employee
Officer/executive
Not working
DK/CS
Other (specify)
Q17
What is your spouse’s occupation?
Housewife
Agricultural labourer
Other Labourer
Farmer
Artisan
Petty trader/shop owner
Petty trader/shop owner
Unskilled worker
Skilled worker
Self employed
Clerical/supervisory/sales person
Government Employee
Officer/executive
DK/CS
Other (specify)
Q18
Are you engaged in the said work throughout the year or seasonally for few months and only once in a while?
Work throughout the year
Work seasonally (Specify months)
Once in a while (Specify)
Q19
What is your average monthly household income?
Below Rs. 1,500 1,500
Rs. 1,501-3,000 Rs. 1,501-3,000
Rs. 3,001-5,000 Rs. 3,001-5,000
Rs. 5,001-7,000 Rs. 5,001-7,000
Rs. 7,001-10,000 Rs. 7,001-10,000
Rs. 10,001-15,000 Rs. 10,001-15,000
Rs. 15,001-20,000 Rs. 15,001-20,000
Rs. 20,001-25,000 Rs. 20,001-25,000
Rs. 25,001-30,000 Rs. 25,001-30,000
Rs. 30,001-35,000 Rs. 30,001-35,000
Rs. 35,001-40,000 Rs. 35,001-40,000
Rs. 40,001-45,000 Rs. 40,001-45,000
Rs. 45,001-50,000 Rs. 45,001-50,000
Rs. 50,001-100,000 Rs. 50,001-100,000
Above Rs. 100,000 Above Rs. 100,000
No income
Do not know
Refused
Q20
In your household, who usually makes decisions about purchases for daily household needs e.g. soap, food items, vegetables etc.?
Self
Wife
Mother
Father
DK/CS
Someone else (Please specify)
Q21
Who usually makes decisions about major household purchases e.g. buying an asset, TV, bed etc.?
Self
Wife
Mother
Father
DK/CS
Someone else (Please specify)
Q22
Who usually makes decisions about visits to family or relatives e.g. going to attend family functions etc.?
Self
Wife
Mother
Father
DK/CS
Someone else (Please specify)
Q23
Do you/ your household members save money?
Yes
No
Q24
For what purpose / reasons do you / your household members save money?
To have extra money for any unforeseen contingencies
To help my family that stays away
To repay loan that I / my household member had taken
To support the studies of my children
For marriage of my children
For purchasing some asset / land
Pregnancy related expenditure
Others (Specify)
Q25
Where do you or the members of your household save money?
SHG / Cooperative
Bank in the village
Bank outside the village
Post-office
Friends/Relative
MFI
Keep at home in a safe place e.g. Gullak
Others specify
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