GetCounted:About You

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Personal Details

Email Id*
Confirm Email Id *

Alternate Email Id(Optional)
Password *

Confirm Password *
Gender*

First Name *

Last Name

Date of Birth*

(Click here to choose date)

Mother Tongue*
Preferred language of reading *		*

Native State *
Community *
Caste *
Religion *
Highest level of education *
Marital status *		*

Current occupation*

Do you stay in a village (rural area)or a town/city (urban area) *

About the Chief Wage Earner of the household: Chief wage earner is the one who contributes the maximum income towards the household expenses.

Which of the following members are staying with you?*

Parents/(In laws)SiblingsOther Non Relative
Married ChildAny Other Relative(not spouse)Spouse
Unmarried Child

How many earning members are there in your household (family members sharing the same kitchen)?*
Are you chief wage earner of your household?*

How is the Chief Wage Earner related to you? *

Out of the following options of education, which is the one that applies to your*
Out of the following options of occupation, which is the one that applies to your*

Marital status of Chief Wage Earner *
Age of the Chief Wage Earner (in years)
Land owned by Chief Wage Earner *
Preferred language reading of Chief Wage Earner *

Contact Details

State *		District*
Town/City*
Other Town/City*		Block/Tehsil*
Address:*
Street/House No.*		Pin Code *
Contact No. Res *		Mobile No. (+91)

Economic Status

Vehicles owned in the household (Choose all that apply)

Bi-Cycle

Motor-Cycle/Scooter

Small Car(Up to Rs.4 lakhs)

Mid-Size Car Rs.4 to 8 lakhs

Luxury Car( Above Rs.8 lakhs)

MUV/SUV

Tractor

Other

Do not own any vehicle

Monthly household income *

Credit card (individually owned by you) *

Which of the following documents do you have?
Voter id *
Passport *
Ration card *
Driving License *

Has anyone in your household taken any of the following loans, which are currently running? *

Which of the following things you have inherited?*

HouseResidential landRegular sources of income(Shares/Dividends)
Agricultural landBusinessOther financial assets(Jewellery etc.)
None

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