STATE

SECTOR

RIC

HH NO

SOCIAL CAPITAL AND COMMUNITY PARTICIPATION

ITEM CODE

SOURCE OF INCOME/CASH RECEIPT 1ST VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT SECOND VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT THIRD VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT FOURTH VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT FIFTH VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT SIXTH VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

SOURCE OF INCOME/CASH RECEIPT SEVENTH VISIT 1 Wages/Salary of Head 2 Commissions and Bonuses 3 Overtime 4 Wages/Salary of Spouse 5 Commissions and Bonuses (spouse) 6 Overtime (Spouse) 7 Wages/Salary of Male Members 8 Commission and Bonuses (Males) 9 Overtime (Males) 10 Wages/Salary of Female Members 11 Commissions and Bonuses (Female) 12 Overtime (Females) 13 Sales of Farm Product 14 Profit From Trading 15 Fees From Prov. Activities 16 Total Basic Income 17 Income from Subsidiary Group 18 Rent Received 19 Loan raised 20 Loan Repayment Received 21 Esusu Received 22 Divident on Shares 23 Pools Winning 24 Sales of Property 25 Cash Gift Received 26 Dowry Received 27 Withdrawal from Saving 28 Remit. Received from within Nig. 29 Remit. Received From Outside Nig. 30 Pension/Gratuity 31 Other 32 TOTAL OTHER CASH RECEIPTS 33 At the beggining of first visit of survey month 34 Imputed Rent from owner occuppied/Rent free Building

TOTAL