SP90-LII
Make one copy
For KS District/Municipality
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTI CS
1990 POPULATION CENSUS
COMPLETE ENUMERATION
HOUSEHOLD MEMBERS LISTING
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
1.
2.
3.
4.
Confidential
I. IDENTIFICATION
CODE
Province
1
District/Municipality*)
3
Sub-District
5
Village/’Kelurahan’ *)
8
Area
Urban
-1
Rural
-2
11
Enumeration Area Number
12
Number of enumeration area subdivisions
16
Physical Building Number
17
Census Building Number
20
Household Serial number
23
Household
Ordinary -1
Particular -2
26
Number of Household members
27
II. ENUMERATION PARTICULARS
Detail
Enumerator
Supervisor
(1)
(2)
(3)
Name of Personnel
NIP/NMS
Date of enumeration/
s.d
s.d
supervision
Signature
*) cross out inapplicable category
Serial
number
Name of
household
members
(Write down
every person
who usually
live and eat in
this household,
whether adults,
children, or
babies)
Relation
with the
head of
household
Age
(year)
III. HOUSEHOLD MEMBERS LISTING
Gender
Marital status
Male
Female
Single
Married
Divorced
Widowed
OTHER THAN THOSE WHO HAVE
ALREADY BEEN REGISTERED:
1. Are there any babies or children who have not
yet been registered yet?
YES write in the list
NO
Name: ………………..
2. Is there anybody else who is not a relative such
as a servant, a person who stays in this
household, or a friend who usually lives here?
YES write in the list
NO
Name: ………………..
3. Are there guests who have lived here for 6
months or more?
YES write in the list
NO
Name: ………………..
4. Is there anybody who usually lives here but is
currently away for less than 6 months?
YES write in the list
NO
Name: ………………..
5. Is there anybody who has been registered but is
currently away for 6 months or more?
YES cross out from the list
NO
Name: ………………..
TOTAL
Verification: - Serial number of the last column(….= Total column (5) + (6) = Total column (7) + (8) + (9) + …)