CENSUS – 2027
The details we need to provide are listed below (in order). If you fill this out on a piece of
paper and keep it ready, you can provide the details very quickly when the Census Officer
visits.
1. Building Number / House Number: ....................................................
2. Type of Floor: ☐ Mud ☐ Cement ☐ Tiles/Marble ☐ Other
3. Type of Wall: ☐ Brick ☐ Concrete ☐ Wood ☐ Other
4. Type of Roof: ☐ Concrete ☐ Sheet ☐ Tile ☐ Other
5. Use of House: ☐ Residential ☐ Residential + Shop ☐ Shop Only
6. Condition of House: ☐ Good ☐ Average ☐ Poor
7. Total Number of Residents in the House: ............. Names:
....................................................
8. Male: ............. Female: ............. Others: .............
9. Name of Head of Household: ....................................................
10. Gender of Head of Household: ☐ Male ☐ Female ☐ Other
11. Category: ☐ SC ☐ ST ☐ Other
12. House ownership: ☐ Owned ☐ Rented ☐ Other
13. Number of Living Rooms: .............
14. Number of Married Couples: .............
15. Source of Drinking Water: ☐ Tap Water ☐ Well ☐ Borewell ☐ Other
16. Availability of Drinking Water: ☐ Within the House ☐ Near the House ☐ Away
17. Source of Lighting: ☐ Electricity ☐ Solar ☐ Other
18. Latrine facility: ☐ Yes ☐ No
19. Type of Latrine: ☐ Flush ☐ Pit ☐ Other
20. Drainage Facility: ☐ Drainage Available ☐ No
21. Bathroom: ☐ Yes ☐ No
22. Kitchen / LPG Connection: ☐ Yes ☐ No
23. Cooking Fuel: ☐ LPG ☐ Firewood ☐ Electric ☐ Other
24. Radio: ☐ Yes ☐ No
25. Television: ☐ Yes ☐ No
26. Internet Facility: ☐ Yes ☐ No
27. Computer / Laptop: ☐ Yes ☐ No
28. Phone: ☐ Landline (Normal) ☐ Smartphone
29. Vehicle - Bicycle: ☐ Yes ☐ No
30. Bike / Scooter: ☐ Yes ☐ No
31. Car / Jeep / Van: ☐ Yes ☐ No
32. Main Staple Food / Grain: ☐ Rice ☐ Wheat ☐ Other
33. Mobile Number: ....................................................