REPUBLIC OF INDONESIA CENTRAL BUREAU OF STATISTICS 1996 NATIONAL SOCIO-ECONOMIC SURVEY CONSUMPTION / HOUSEHOLD EXPENDITURES INFORMATION

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2 SUSENAS REPUBLIC OF INDONESIA CENTRAL BUREAU OF STATISTICS 1996 NATIONAL SOCIO-ECONOMIC SURVEY CONSUMPTION / HOUSEHOLD EXPENDITURES INFORMATION VSEN96.M CONFINDENTIAL I. LOCATION IDENTIFICATION II. ENUMERATION PARTICULARS 01 Province 01 Name and employment identity number of enumerator 02 District/Municipality*) 03 Sub-District 04 Village / village unit *) 05 Area type Urban -1 Rural Enumerator s Status Province KS staff 1 District/municipality 2 KS staff Mantis 3 Partner 4 06 Enumeration area number 03 Date of enumeration 07 Segments group number 04 Enumerator s signature 08 Segment number 05 Name and employment identity 09 Sample code number number of supervisor 10 Sample serial number of household 11 Village classification Tertinggal tdk tertinggal 12 Household head name 13 Number of household members 14 Address (name of road /alley, home number, RT/RW) Filled in by editor Filled in by editor 06 Supervisor s Status Province KS staff 1 District/municipality 2 KS staff Mantis 3 07 Date of supervision 08 Supervisor s signature 2

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4 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTION DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total of consumption s Total (4) + (6) (0,00) (0,00) (0,00) (1) (2) (3) (4) (5) (6) (7) (8) (9) 001 A. Cereals 002 Local rice Kg 003 High quality rice s Kg 004 Imported rice Kg 005 Glutinous rice Kg 006 Wet corn with skin Kg 007 Dry corn with skin Kg 008 Dry-shelled corn Kg 009 Rice flour Kg 010 Corn flour (maizena) Kg 011 Wheat flour Kg 012 Other. Kg 013 B. Tuber Kg 014 Cassava Kg 015 Sweet potato Kg 016 Potato Kg 017 Taro Kg 018 Dried cassava Kg (5) + (7) 4

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6 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 019 Cassava flour (Tapioca) Kg 020 Dried-cassava flour Kg 021 Sago (not made from cassava, Kg example: Ambon Sago) 022 Other:. Kg 023 C. Fish 1] Fresh fish 024 Yellow tail fish Kg 025 Tuna Kg 026 Tenggiri /Spanish mackerel Kg 027 Selar /mackerel Kg 028 Kembung fish 029 Teri Kg 030 Bandeng milkfish Kg 031 Gabus fish Kg 032 Tilapia fish Kg 033 Gold fish Kg (5) + (7) 6

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8 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 034 Lele fish (catfish) 035 Kakap fish Kg 036 Other. Kg 2] Shrimp and other fresh animal s Kg water 037 Shrimp/Dried shrimps Kg 038 Squid Kg 039 Crab Kg 040 Shell/snail Kg 041 Other. Kg 3] Preserved fish Kg 042 Kembung fish Ounce 043 Tenggiri fish Ounce 044 Tuna fish Ounce 045 Teri Ounce 046 Selar fish Ounce 047 Sepat fish Ounce (5) + (7) 8

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10 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 048 Bandeng fish Ounce 049 Gabus fish Ounce 050 Canned fish Ounce 051 Other. Ounce 4] Shrimp and other preserved water animals 052 Shrimp (Dried shrimp) Ounce 053 Squid Ounce 054 Other. Ounce 055 D. Meat 1] Fresh meat 056 Beef Kg 057 Buffalo Kg 058 Goat Kg 059 Pork Kg 060 Purebred chicken Kg 061 Free range chicken Kg (5) + (7) 10

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12 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 062 Other poultry meats Other meats.. Kg 2] Preserved meats Kg 064 Dried meat Kg 065 Dried shredded meat Ounce 066 Meat in a can Kg 067 Other. Kg 3] Other Kg 068 Liver Kg 069 Innards (other than liver) Kg 070 Tetelan (bones with a bit of Kg adhering meat) 071 Bones Kg 072 Other. Kg 073 E. Egg and milk Kg 074 Egg of purebred chicken Kg (5) + (7) 12

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14 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 075 Egg of free range chicken Pieces 076 Duck egg Pieces 077 Quail egg Pieces 078 Other eggs Pieces 079 Salted egg Pieces 080 Pure milk Liter 081 Factiry-processed liquid milk 250ml *) 082 Sweetened condensed milk 397gr **) 083 Powder milk Kg 084 Baby powder milk 400gr ***) 085 Cheese Ounce 086 Other dairy product:. Ounce 087 F. Vegetables 088 Spinach Kg 089 Water Spinach Kg 090 Cabbage Kg *) box (5) + (7) 14

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16 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 091 Chinese cabbage ( petsai ) Kg 092 Mustard greens Kg 093 Green bean Kg 094 Long beans Kg 095 Tomato Ounce 096 Carrot Kg 097 Cucumber Kg 098 Leaves of cassava Kg 099 Eggplant Kg 100 Soya bean sprouts Kg 101 Squash Kg 102 Baby corn Ounce 103 Vegetables soup/stir-fried Package vegetables 104 Sayur asam (sour soup) Package 105 Young jack fruit Kg 106 Unripe papaya Kg 107 Mushroom Ounce (5) + (7) 16

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18 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 108 Petai (beans with pungent odor) Kg 109 Jengkol (Phithecolobium) Kg 110 Shallot Ounce 111 Garlic Ounce 112 Red pepper Ounce 113 Green pepper Ounce 114 Small chili Ounce 115 Vegetables in a can Kg 116 Other.. Kg 117 G. Pulses 118 Peanut with skin Kg 119 Peanut without skin Kg 120 Soy bean Kg 121 Mung bean Kg 122 Cashew nut Ounce 123 Other peanuts Kg (..) (5) + (7) 18

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20 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 124 Tofu Kg 125 Tempe Kg 126 Fermented soy bean sauce Ounce 127 Oncom Ounce 128 Other. Ounce 129 H. Fruits 130 Orange Kg 131 Mango Kg 132 Apple Kg 133 Avocado Kg 134 Rambutan Kg 135 Lanzon Kg 136 Durian Kg 137 Snake fruit Kg 138 Pineapple Kg 139 Banana Kg (5) + (7) 20

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22 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 140 King Raja banana Kg 141 Other banana Kg Kg 142 Papaya Kg 143 Jambu (rose-apple) Kg 144 Sawo (Sapodilla) 145 Star fruits 146 Kedondong Kg 147 Watermelon Kg 148 Melon Kg 149 Jack fruit Kg 150 Tomato Kg 151 Fruits in a can Kg 152 Other.. Kg 153 I. Oil and fat Kg 154 Coconut oil Liter 155 Corn oil Liter (5) + (7) 22

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24 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 156 Other cooking oil: Liter 157 Coconut pieces 158 Margarine Ounce 159 Other J. Beverages ingredients 161 Granulated sugar Ounce 162 Palm sugar Ounce 163 Tea Ounce 164 Powdered coffee Ounce 165 Coffee bean Ounce 166 Cocoa powder Ounce 167 Syrup (fruit syrup concentrate for 620ml drink) 168 Other. 169 K. Spices 170 Salt Ounce 171 Candlenut Ounce (5) + (7) 24

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26 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 172 Coriander/caraway seed Ounce 173 Pepper Ounce 174 Tamarind Ounce 175 Nutmeg Ounce 176 Clove Ounce 177 Fish paste Ounce 178 Soy sauce 10 ml 179 Monosodium glutamate Gram 180 Sambal (chili sauce) /tomato 140 ml sauce 181 Prepared spices Ounce 182 Other spices. 183 L. Other consumption 184 Fish/shrimp crakcers Ounce 185 Emping chip Ounce 186 Wet noodle Kg 187 Instant noodle 80 gr (5) + (7) 26

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28 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 188 Rrice noodle Ounce 189 Macaroni/ dried noodle Ounce 190 Jelly Pack (7 gr)*) 191 Baby porridge (packaged) 150 gr 192 Other M. Prepared foods & drinks 194 Bread Small pack 195 Sweet bread/other bread Piece 196 Cookies/Biscuit/ semprong Ounce 197 Cake Piece 198 Fried food Piece 199 Mungbean porridge Bowl 200 Gado-gado/ ketoprak/ pecel Plate 201 Rice and side dishes (nasi rames) Plate 202 Fried rice Plate 203 Rice Plate *) Small pack (5) + (7) 28

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30 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total of consumption s Total (4) + (6) (0,00) (0,00) (0,00) (1) (2) (3) (4) (5) (6) (7) (8) (9) Bowl 204 Lontong (ice steamed in a banana leaf)/ Ketupat sayur (rice cake with vegetables) 205 Soto /curry/ soup/ rawon /mince Bowl 206 Sate / Tongseng (goat stir-fry) Plate 207 Meat ball noodle/boiled Bowl noodle/fried noodle 208 Instant noodle Bowl 209 Snack for kids/fish or shrimp Ounce crackers/chips 210 Fish (fried, baked, etc) Piece 211 Chicken/meat (fried, baked, etc) Piece 212 Ice cream Small bowl 213 Other ice Glass 214 Other prepared food Soft drink with CO2 (soda) 200 ml *) Beverages without CO2: 216 Packaging water 500 ml **) 217 Packaging tea 200 ml ***) *) Small Glass Bottle **) Small Plastic Bottle ***) Tea bottle packaging (5) + (7) 30

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32 III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEK Purchase (cash/owed) Private production, given, etc. NO Details Standard unit Total Total Total (4) + (6) (0,00) (0,00) (0,00) Total of consumption s (1) (2) (3) (4) (5) (6) (7) (8) (9) 218 Packaged fruit juice 200 ml* 219 Health drink/energy drinks Bottle ** (100 ml) 220 Other drinks (coffee, milk coffee, Glass tea, chocolate milk) 221 N. Alcoholic drinks 222 Beer 620 ml 223 Wine 620 ml 224 Other alcoholic drinks. 620 ml O. Tobacco and betel 226 Filtered clove cigarette 10 pieces 227 Unfiltered clove cigarette 10 pieces 228 White tobacco cigarette 10 pieces 229 Tobacco Ounce 230 Betel leaves/areca nut 231 Other.. * Boxed packaging ** Small bottle (5) + (7) 32

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34 III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 232 A. Housing and Household facility 233 The house of living is: Owned property/free of rent 1 Installment payment 4 Lease 2 Official house 5 Rent 3 Other If the house is own property/free of rent, estimated monthly rent: Rp If the house is leased: a. Lease agreement:.year b. Lease value: Rp... c. Average monthly lease value: Rp. 236 If the house is rented, monthly rent value: Rp If the status of dwelling is installment, official and others, average monthly rent value: Rp. 238 Maintenance costs (paint, plastering, painting the wall, replacing roof tiles, broken glass, hinge, etc, including wages for workers) 239 Electricity: 240 : 241 Telephone : Used electricity (quantity): a. A month ago:...kwh/watt *) Fill in by b. 12 months ago:.kwh/watt *) CBS 34

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36 III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 242 Water ( PAM = Municipal Water Corporation / from water vendor/ purchased) Quantity: a. A month ago: m3 b. 12 months ago:.m : LPG (Liquid Propane Gas) Quantity: a. A month ago: kg b. 12 months ago:.kg City Gas Quantity: a. A month ago: m3 b. 12 months ago:.m : Kerosene Quantity: a. A month ago: m3 b. 12 months ago:.m Generator a. Type and number of fuel used: Gasoline 1 Kerosene 3 A month ago:..liter Diesel 2 12 months ago: liter

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38 III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 252 b. Lubricants: Quantity: a. A month ago: liter b. 12 months ago:.liter : c. Maintenance and repair Charcoal Quantity: a. A month ago: kg b. 12 months ago:.kg Firewood and other fuel 258 Others (flashlight, storage battery, matches, mosquito repellent, lamp, air freshener, Liquid floor cleaner, etc) Goods and Services Bath soap, toothpaste, toothbrush, and shampoo 261 Cosmetics (perfume, pomade, deodorant, powder, lipstick, comb, etc), and sanitary napkin 262 Treatments for skin, face, nails, hair (cut, curl, cream bath, etc) 38

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40 III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) Health a. Government s hospital b. Private s hospital c. Doctor s practice d. Puskesmas (Integrated Health Center) e. Supporting Puskesmas f. Clinic/ Mother and Child s Clinic / BP (infirmary) g. Posyandu (Integrated Health Services Post)/Cader h. Midwife/paramedic/practicing nurses i. Traditional healer/shinshe (Chinese traditional healer) j. Purchased medication with doctor s prescription k. Own treatment/purchased medicine without doctor s prescription/purchased medicinal herbs Other health: 274 a. Pregnancy examination cost 275 b. Delivery cost 276 c. Immunization cost for children under 5 years 277 d. Check-up and contraceptive costs 278 Health treatment (vitamin, herbs, massage, fitness, etc) School & courses expenses a. Donation for school development (school enrollment fee) b. School tuition (SPP) and BP3/POMG contribution c. Other school contributions (vocational skills, additional lesson, exams, etc.) d. Textbooks/photocopy of textbooks e. Stationeries (calculator, compass, etc) f. Course fee 40

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42 III. 2. EXPENDITURE FOR NON-FOOD CATEGORY LAST MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 285 Newspapers, magazines, books, and stationery (excluding school and course needs) including rent of magazines/literatures 286 Post, Telegram, public phone, and postal materials, including pager fee Motor vehicle fuels used for household needs (not for business/work) a. Gasoline Quantity: (1) A month ago:.liter (2) 12 months ago:..liter : b. Solar fuel Quantity: (1) A month ago:.liter (2) 12 months ago:..liter : 291 c. Lubricant oil Quantity: (1) A month ago:.liter (2) 12 months ago:..liter 292 : 293 Maintenance and repairs of motor vehicle 294 Costs of transportation (bus, train, airline, ship, becak, parking fee, toll fee, etc) 295 Hotel, motel, cinema, theatre, sport, decoder, and other recreations, (excluding transportation cost and purchase of goods for recreation) 296 Servant and driver (wages or salary) 297 Other goods (tissue, camphor, banana leaves, coconut leaves, sate stick, etc) 298 Other services (Identity card, Driver license, birth certificate, photo copy, 42

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44 III. 2. EXPENDITURE FOR NON FOOD CATEGORY LAST MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 299 C. Clothes, Footwear, and Head gear 300 Ready made men s wear (Blazer, long-sleeved shirt, Jacket, sarong, pants, T-shirt, underwear, etc) 301 Ready made women s wear (Gown, long fabric, blouse, nightgown, sweater, skirt, sarong, shawl, cloth girdle, underwear, etc) 302 Ready made children s wear (clothes, pants, sweater, shirts, under wear, baby napkin, etc) 303 Materials/fabrics for men, women, and children (wool, polyester, cotton, silk, etc) 304 Cost for tailoring, clothes repair, thread and other sewing needs 305 Footwear for men (shoes, sandal, sock, etc) 306 Footwear for women 307 Footwear for children 308 Head gear for man, woman and children (hat, kopiah =rimless cap, veil, etc) 309 Laundry-soap (in bar form) 310 Powder soap and cream soap 311 Others (towel, belt, shoe polish, tie, laundry, etc) 44

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46 III. 2. EXPENDITURE FOR NON FOOD CATEGORY LAST MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 312 D. Durable goods 313 Furniture ( table, chair, bed, wardrobe, cabinet, shelving, mirror, food cabinet, baby bed, etc) 314 Household equipment (sewing machine, refrigerator, fan, washing machine, air conditionner, etc) 315 Household furnishings (mattress, pillow, table cloth, bed sheet, mirror, pillow sheet, blanket, plaited mat, curtain, carpet, etc) 316 Household utensils (Iron, broom, scissors, knife, machete, saw, vacuum cleaner, etc) 317 Kitchen/eating utensils (plate rack, stove, cooking pan, pan, pail, wok, spoon, thermos bottle, plate, glass, and other utensils made of glass, ceramic, melamine, and plastic; mixer, blender, microwave, oven, etc) 318 Decorative goods (wall decoration, aquarium, decoration goods made of ceramic, porcelain, onyx, marble, wood, etc) 319 Repaired of household furniture, furnishings and equipment 320 Watch, clock, camera, glasses, and their repair 321 Umbrella, bag, luggage, and their repair 322 Expensive jewelers (gold, diamond, pearl, etc) and their repair 323 Children s toy and their repair 324 Television, video, radio, cassette, radio cassette, guitar, piano/organ, computer, and their repair 325 Sport utensils (chess, racket, ball, net, bet, stick, etc) and their repair 326 Vehicle (bicycle, motor cycle, car, etc) and their repair 327 Pets and plants including maintenance 328 Other durable goods (cradle, baby carriage, electricity installation, telephone, plumbing, pager, and their repair 46

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48 III. 2. EXPENDITURE FOR NON FOOD CATEGORY PAST MONTH AND 12 MONTHS AGO NO DETAIL in Rupiah A month ago 12 month ago (1) (2) (3) (4) 329 Taxes and insurance: 330 Building and Land tax (PBB) 331 Radio & TV tax, and its type 332 Vehicle (motor and non motor) tax 333 Other taxes/levies (household contribution, garbage, security, cemetery, etc) 334 Accident & loss insurance 335 F. Festivities and ceremonies 336 Weeding (rentals for facilities and services, function hall rental, etc) 337 Circumcision, birthday 338 Religious holidays ( Idul Fitri = holiday celebrating the end of fasting period, Idul Adha, Christmas, New Year, Waisak = Budhist New Year, Galungan = Hindu Holy Day, expenses for going to Mecca for Haj 339 Other Traditional ceremonies ( selametan, party, sajen = offerings, etc) 340 Funeral 48

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50 III. 3. AVERAGE MONTHLY HOUSEHOLD EXPENSES ( IN RUPIAH) NO Type of expenses During a week Average in a month (1) (2) (3) (4) (5) 01 Cereals (III.1 A) 02 Tuber (III. 1 B) 03 Fish (III. 1 C) 04 Meat (III. 1 D) 05 Egg and Milk (III. 1 E) 06 Vegetables (III. 1 F) 07 Pulses (III. 1 G) 08 Fruits (III. 1 H) 09 Oil and Fat (III. 1 I) 10 Drinks (III. 1 J) 11 Spices (III. 1 K) 12 Other consumables (III. 1 L) 13 Prepared foods and drinks (III. 1 M) 14 Alcoholic drink (III. 1 N) 15 Tobacco and betel (III. 1 O) 16 Sub Total (1 to 15) 17 Sub total (16) x Housing and Household facility (III. 2 A) 19 Goods and Services (III. 2 B) 20 Clothes, Footwear, and Headgear (III. 2 C) 21 Durable goods (III. 2 D) 22 Tax and Insurance (III. 2 E) 23 Festivities and ceremonies (III. 2 F) 24 Average monthly expenses(17 to 23) During 12 months 50

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52 IV. INCOME, REVENUE AND EXPENSES FOR NON FOOD CATEGORY DURING THE PAST 12 MONTHS (IN RUPIAH) 1. Wages/salary received in cash and in kind 2. Income from agriculture business/activities a. Food and non-food crops b. Other farming activities(livestock, poultry, miscellaneous livestock, fishery, forestry) 3. Income from non agriculture business/activities 4. Income outside of wage/salary and business a. Estimated house rent b. Other (pension, duty-binding scholarship/ scholarship, claimed life insurance, dividend, land lease, others) 5. Expenses and money transfers received Expenses: (transferred money, give donation, gift, bequest, and aid) 6. Other expenses and revenue Revenue: (received money transfers, inheritance, donation, gift, aid) Expenses: Revenue: a. Purchased stock/bonds/gold/jewelry, immovable goods a. Sold of bond/gold/jewelry/immovable goods, secondincluding building renovation hand goods b. Others (saving, paid of insurance, loans/paid back loans, b. Others (withdrew savings, claimed other insurance, down payment, paid arisan = social gathering received arisan, received loans, panwed goods, etc whose member contribute to and take turns sum of money, etc) 7. Income/revenue of household (Total of income/revenue, details 1 to 6 total expenses, details 5 to 6) 8. Average income/revenue of household in a month (details 7 : 12) 52

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54 V. HOUSEHOLD MEMBERS RICE CONSUMPTION FREQUENCY AND NUMBER OF CLOTHES Frequency of rice Number of clothes owned at eaten previous week time of enumeration No Name Prepared Prepared Tops Skirt/sho Dress at home food rts/pants (1) (2) (3) (4) (5) (6) (7) Dairy cow Cow Buffalo Horse Goat Sheep Pig Free range chicken Layer chicken Broiler chicken Ducks VI. LIVESTOCK AND POULTRY LISTING 1. Do you have livestock/poultry at time of enumeration? Yes 1 No 2 finished 2. If yes, number of livestock/poultry raised: Type of livestock/poultry male female Total (1) (2) (3) (4) 54

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56 VII. NOTE 56