PROVINCE ____
NUMBER OF LAYER _______
URBAN DISTRICT/DISTRICT _________
CLUSTER __________
STRUCTURE _________
HOUSEHOLD ________
WOMAN'S LINE NUMBER _________
NUMBER OF COUNTING ZONE ________

IDENTIFICATION

PROVINCE ___
DEPARTMENT ___
LAYER ___
DISTRICT ___

IDENTIFICATION

PROVINCE ___
DEPARTMENT ___
LAYER ___
DISTRICT ___

IDENTIFICATION

LOCALITY NAME: ___
NAME OF HEAD OF HOUSEHOLD: ___
REGION: ___
CLUSTER NUMBER: ___
STRUCTURE NUMBER: ___
HOUSEHOLD NUMBER: ___
NAME OF HEAD OF HOUSEHOLD AND HOUSEHOLD NUMBER: ___
NAME AND LINE NUMBER OF WOMAN: ___

IDENTIFICATION
REGION
DIVISION
SUB-DIVISION
LOCALITY
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN