the sixth national population census enumeration form …

The Sixth National Population Census Enumeration Form Long Form [unofficial translation] This Form is approved by the State Council for the Sixth National Population Census Enumeration. The Population Census Enumeration Standard Reference Time Point is set at 0:00 AM on November 1, 2010. The original Population Census data will not be provided to any agency or individual. They are for aggregate use only. Citizens must fulfill their obligations to accurately report the items on the Population Census Enumeration Form. Form Number: R602 Form Form creation Organization: National Bureau of Statistics of China Office of the Sixth National Population Census, the State Council Document Approval Number: National Development (or Guo Fa) [2009] No. 23 Valid until: December 2010 Address of this Household: County [Xiàn], County-level City [Shì] Township [Xiāng], Town [Zhèn] _ City District [Qū] _______ Street, Road [Jie Dào] ______ Census District [Pǔ chá qū] _____ Census sub-District [Pu chá xiǎo qū] Housing unit ID Number _______ Address Code: __ __ __ __ __ __ __ __ __ __ __ __ __ ========================================================================================================= H1. Household ID Number: No. ____________ __ __ __ H2. Type of Household: 1. Family household 2. Collective quarters __ H3. The number of persons who should be registered in this household: The number of persons who slept in this household at the night of October 31, 2010: _____ persons __ __

The number of persons who have the Household Registration under this household, but did not sleep in this household at the night of October 31, 2010: _____ persons

__ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- H4. 2009. 11. 1 -- 2010. 10. 31: Births: Male ______ persons. Female _________ persons __ __ Deaths: Male ______ persons. Female _________ persons __ __

H5. Housing Unit Usage: 1. Housing unit is used as lliving quarters 2. Use as lliving quarters as well as for production and conducting business. 3. Don't have a housing unit (End) __ H6. Building construction area of this housing unit for this household: __________ Square Meters __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- H7. The number of rooms in this housing unit for this household: Number of rooms______________ __ __ H8. Number of stories of this housing unit for this household: 1. One story housing unit (Bungalow, ranches, etc.) 2. 2-3 stories building 3. 4-6 stories building 4. 7-9 stories building 5. 10 or more stories building __ H9. Type of the weight bearing of the structure: 1. Steel and steel reinforced concrete structures 2. Mixed structures 3. Brick and wood structures 4. Other structures __ H10. Year of construction for this housing unit: 1. Before 1949 2. 1949-1959 3. 1960-1969 4. 1970-1979 5. 1980-1989 6. 1990- 1999 7. After 2000 __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- H11. The main cooking fuel: 1. Gas 2. Electricity 3. Coal 4. Firewood and hay

5. Other __ H12. Does this housing unit have piped running water? 1. Has 2. Does not have __ H13. Does this housing unit have a kitchen? 1. Used by this household only 2. Shared with other households 3. No kitchen __ H14. Does this housing unit have toilets? 1. Toilet with water tank pumping style used by this household only 2. Toilet with water tank pumping style shared with other households 3. Other type of toilet used by this household only 4. Other type of toilet shared with other households 5. No toilet __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- H15. Does this housing unit have bathing facilities? 1. Central hot water supply for all housing units in the building 2. This household installed their own water heaters 3. Other bathing facility 4. No bathing facility __ H16. Method of acquiring this housing unit: 1. Rent a low-cost rental housing 2. Rent a housing unit that is not a low-cost rental 3. Self-built housing unit | 4. Bought a newly constructed housing unit | 5. Bought a second-hand (existing) housing unit | 6. Bought an affordable housing unit | End 7. bought an original government owned public housing unit | 8. Other | __ H17. Monthly rent expenditure for the housing unit: 1. Less than 100 Yuan 2. 100-200 Yuan 3. 200-500 Yuan 4. 500-1000Yuan

5. 1000-1500 Yuan 6. 1500-2000 Yuan 7. 2000-3000 Yuan 8. Greater than 3000 Yuan __ ===================================================================================================== Complete the following for each person: (First person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 0. Head of the household 1. Spouse 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: (________ Years old in full year) Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __

R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],

Street, Road [Jie Dào]) 4. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 5. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 6. Hong Kong, Macao, Taiwan or in foreign country __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R7. Location of Household Registration: 1. Current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 2. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],

Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R12 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R11 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home

7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. The type of the Location of the Household Registration: 1. Township [Xiāng] 2. Neighborhood Committee [Jū wěi huì] of a Town [Zhèn] 3. Village Committee [Cun wei huì] of a Town [Zhèn] 4. Street, Road [Jie Dào] __ R11. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ R12. Birthplace: 1. Current County [Xiàn] (or County-level City [Shì], City District [Qū]) 2. Other County [Xiàn] (or County-level City [Shì], City District [Qū]) of the current Province 3. Outside current Province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person 5 years old or older: R13. Usual residence five years ago: Usual residence on November 1, 2005: 1. In current province 2. Outside current province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Second person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 1. Spouse 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: (________ years old in full year) Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below:

5. Household status pending -> R12 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R11 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. The type of the Location of the Household Registration: 1. Township [Xiāng] 2. Neighborhood Committee [Jū wěi huì] of a Town [Zhèn] 3. Village Committee [Cun wei huì] of a Town [Zhèn] 4. Street, Road [Jie Dào] __ R11. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ R12. Birthplace: 1. Current County [Xiàn] (or County-level City [Shì], City District [Qū]) 2. Other County [Xiàn] (or County-level City [Shì], City District [Qū]) of the current Province

3. Outside current Province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person 5 years old or older: R13. Usual residence five years ago: Usual residence on November 1, 2005: 1. In current province 2. Outside current province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Third person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: (________ years old in full year) Born in: Year _________ Month _______ __ __ __ __ __ __

R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R12 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R11 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business

2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. The type of the Location of the Household Registration: 1. Township [Xiāng] 2. Neighborhood Committee [Jū wěi huì] of a Town [Zhèn] 3. Village Committee [Cun wei huì] of a Town [Zhèn] 4. Street, Road [Jie Dào] __ R11. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ R12. Birthplace: 1. Current County [Xiàn] (or County-level City [Shì], City District [Qū]) 2. Other County [Xiàn] (or County-level City [Shì], City District [Qū]) of the current Province 3. Outside current Province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person 5 years old or older: R13. Usual residence five years ago: Usual residence on November 1, 2005: 1. In current province 2. Outside current province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Fourth person :) R1. Name: __ __ __ __

R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: (________ years old in full year) Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],

Street, Road [Jie Dào]) 4. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 5. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 6. Hong Kong, Macao, Taiwan or in foreign country __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R7. Location of Household Registration: 1. Current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì])

2. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào])

3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R12 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R11 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. The type of the Location of the Household Registration: 1. Township [Xiāng] 2. Neighborhood Committee [Jū wěi huì] of a Town [Zhèn] 3. Village Committee [Cun wei huì] of a Town [Zhèn] 4. Street, Road [Jie Dào] __ R11. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __

R12. Birthplace: 1. Current County [Xiàn] (or County-level City [Shì], City District [Qū]) 2. Other County [Xiàn] (or County-level City [Shì], City District [Qū]) of the current Province 3. Outside current Province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person 5 years old or older: R13. Usual residence five years ago: Usual residence on November 1, 2005: 1. In current province 2. Outside current province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Fifth person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: (________ years old in full year) Born in: Year _________

Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R12 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R11 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years

__ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. The type of the Location of the Household Registration: 1. Township [Xiāng] 2. Neighborhood Committee [Jū wěi huì] of a Town [Zhèn] 3. Village Committee [Cun wei huì] of a Town [Zhèn] 4. Street, Road [Jie Dào] __ R11. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ R12. Birthplace: 1. Current County [Xiàn] (or County-level City [Shì], City District [Qū]) 2. Other County [Xiàn] (or County-level City [Shì], City District [Qū]) of the current Province 3. Outside current Province _____________ Province __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person 5 years old or older: R13. Usual residence five years ago: Usual residence on November 1, 2005: 1. In current province 2. Outside current province _____________ Province __ __ __ __________________________________________________________________________________________________

(For households with more than five people, starting from the 2nd page of the Population Census Form, you only need to fills in the "H1. Household ID Number" on the household records) [that is you don't need to repeat H2 to H17]

Complete the following for each person age 6 years old or older: (First person) R14. Are you literate? 1. Yes 2. No __ R15. Highest level of education completed: 1. Has never attended school -> R17 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ R16. The status of education completion: 1. Currently enrolled in school 2. Graduated 3. Received a certificate of course completion without receiving the degree diploma [Sì yè] 4. Dropout 5. Other __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 15 years old or older: R17. Work status: During 25-31 of October, did you work for more than one hour in order to earn an income? 1. Yes. Number of hours worked last week _________ hours 2. On vacation, in training or studying, temperately out of work or seasonal without work 3. Did not do any work -> R20 __ __ __ R18. Industry: Full name of your agency [Dānwèi] (as an organization, department, division, section, etc.): Main products or major business __ __ __ R19. Occupation: The specific work that I have engaged in:

-> R23 __ __ __ R20. Reason for not working: 1. Study in school -> R23 2. Disabled 3. Do not have a job after graduation 4. Out of work due to agency [Dānwèi] reasons 5. Out of work due to personal reasons 6. Contracted land for my work was acquired by the government 7. Retired 8. Homemakers 9. Other __ R21. Did you seek for jobs within the past three months? 1. Job seeking at employment or job referral agencies 2. Asked relatives and friends to look for jobs 3. Responded to advertisements or create your own advertisements 4. Participated in the recruitment meetings or job fairs 5. Prepared for self-employment in business 6. Other 7. Has never seek for work __ R22. Ability to work If there is a suitable work for you, can you start to work within two weeks? 1. Yes, I can. Consecutive duration without work _____________ months 2. No, I cannot. __ | __ __ R23. The major source of income 1. Earned income 2. Severance, retirement pension, Social Security payments 3. Unemployment Insurance 4. Social Security subsistence allowances (Supplemental Security Income) 5. Income from property and equity 6. Supported by other family members 7. Other __ R24. Marital status: 1. Single -> R28

2. Married 3. Divorced 4. Widowed __ R25. Marriage (first marriage) date, year and month ______________ Year ___________ Month __ __ __ __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 64 years old: R26. Number of children born: Gave birth (Live Birth): Number of male ________ Number of female _______ Among the live births, how many are still alive? Number of male ________ Number of female _______ __ | __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 50 years old: R27. Child bearing status during period of 2009. 11. 1 - 2010. 10. 31: 1. Did not give birth 2. Gave birth Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ | __ __ | __ If gave birth two or more children within the 12 month period, the status of the second child are: Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ __ | __ --------------------------------------------------------------------------------------------------------------------------------------------------------------------

Complete the following for each person age 60 years old or older: R28. Status of physical health: Have four standard answers: 1. Healthy 2. Basically healthy 3. Not healthy, but can live independently 4. Cannot take care of themselves for the daily routines __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Second person) R14. Are you literate? 1. Yes 2. No __ R15. Highest level of education completed: 1. Has never attended school -> R17 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ R16. The status of education completion: 1. Currently enrolled in school 2. Graduated 3. Received a certificate of course completion without receiving the degree diploma [Sì yè] 4. Dropout 5. Other __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 15 years old or older: R17. Work status: During 25-31 of October, did you work for more than one hour in order to earn an income? 1. Yes. Number of hours worked last week _________ hours 2. On vacation, in training or studying, temperately out of work or seasonal without work 3. Did not do any work -> R20 __ __ __

R18. Industry: Full name of your agency [Dānwèi] (as an organization, department, division, section, etc.): Main products or major business __ __ __ R19. Occupation: The specific work that I have engaged in: -> R23 __ __ __ R20. Reason for not working: 1. Study in school -> R23 2. Disabled 3. Do not have a job after graduation 4. Out of work due to agency [Dānwèi] reasons 5. Out of work due to personal reasons 6. Contracted land for my work was acquired by the government 7. Retired 8. Homemakers 9. Other __ R21. Did you seek for jobs within the past three months? 1. Job seeking at employment or job referral agencies 2. Asked relatives and friends to look for jobs 3. Responded to advertisements or create your own advertisements 4. Participated in the recruitment meetings or job fairs 5. Prepared for self-employment in business 6. Other 7. Has never seek for work __ R22. Ability to work If there is a suitable work for you, can you start to work within two weeks? 1. Yes, I can. Consecutive duration without work _____________ months 2. No, I cannot. __ | __ __ R23. The major source of income 1. Earned income 2. Severance, retirement pension, Social Security payments 3. Unemployment Insurance

4. Social Security subsistence allowances (Supplemental Security Income) 5. Income from property and equity 6. Supported by other family members 7. Other __ R24. Marital status: 1. Single -> R28 2. Married 3. Divorced 4. Widowed __ R25. Marriage (first marriage) date, year and month ______________ Year ___________ Month __ __ __ __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 64 years old: R26. Number of children born: Gave birth (Live Birth): Number of male ________ Number of female _______ Among the live births, how many are still alive? Number of male ________ Number of female _______ __ | __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 50 years old: R27. Child bearing status during period of 2009. 11. 1 - 2010. 10. 31: 1. Did not give birth 2. Gave birth Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ | __ __ | __

If gave birth two or more children within the 12 month period, the situation of the second child are: Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 60 years old or older: R28. Status of physical health: Have four standard answers: 1. Healthy 2. Basically healthy 3. Not healthy, but can live independently 4. Cannot take care of themselves for the daily routines __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Third person) R14. Are you literate? 1. Yes 2. No __ R15. Highest level of education completed: 1. Has never attended school -> R17 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ R16. The status of education completion: 1. Currently enrolled in school 2. Graduated 3. Received a certificate of course completion without receiving the degree diploma [Sì yè] 4. Dropout 5. Other __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 15 years old or older:

R17. Work status: During 25-31 of October, did you work for more than one hour in order to earn an income? 1. Yes. Number of hours worked last week _________ hours 2. On vacation, in training or studying, temperately out of work or seasonal without work 3. Did not do any work -> R20 __ __ __ R18. Industry: Full name of your agency [Dānwèi] (as an organization, department, division, section, etc.): Main products or major business __ __ __ R19. Occupation: The specific work that I have engaged in: -> R23 __ __ __ R20. Reason for not working: 1. Study in school -> R23 2. Disabled 3. Do not have a job after graduation 4. Out of work due to agency [Dānwèi] reasons 5. Out of work due to personal reasons 6. Contracted land for my work was acquired by the government 7. Retired 8. Homemakers 9. Other __ R21. Did you seek for jobs within the past three months? 1. Job seeking at employment or job referral agencies 2. Asked relatives and friends to look for jobs 3. Responded to advertisements or create your own advertisements 4. Participated in the recruitment meetings or job fairs 5. Prepared for self-employment in business 6. Other 7. Has never seek for work __ R22. Ability to work If there is a suitable work for you, can you start to work within two weeks? 1. Yes, I can. Consecutive duration without work _____________ months

2. No, I cannot. __ | __ __ R23. The major source of income 1. Earned income 2. Severance, retirement pension, Social Security payments 3. Unemployment Insurance 4. Social Security subsistence allowances (Supplemental Security Income) 5. Income from property and equity 6. Supported by other family members 7. Other __ R24. Marital status: 1. Single -> R28 2. Married 3. Divorced 4. Widowed __ R25. Marriage (first marriage) date, year and month ______________ Year ___________ Month __ __ __ __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 64 years old: R26. Number of children born: Gave birth (Live Birth): Number of male ________ Number of female _______ Among the live births, how many are still alive? Number of male ________ Number of female _______ __ | __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 50 years old: R27. Child bearing status during period of 2009. 11. 1 - 2010. 10. 31: 1. Did not give birth 2. Gave birth

Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ | __ __ | __ If gave birth two or more children within the 12 month period, the situation of the second child are: Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 60 years old or older: R28. Status of physical health: Have four standard answers: 1. Healthy 2. Basically healthy 3. Not healthy, but can live independently 4. Cannot take care of themselves for the daily routines __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Fourth person) R14. Are you literate? 1. Yes 2. No __ R15. Highest level of education completed: 1. Has never attended school -> R17 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ R16. The status of education completion: 1. Currently enrolled in school 2. Graduated 3. Received a certificate of course completion without receiving the degree diploma [Sì yè]

4. Dropout 5. Other __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 15 years old or older: R17. Work status: During 25-31 of October, did you work for more than one hour in order to earn an income? 1. Yes. Number of hours worked last week _________ hours 2. On vacation, in training or studying, temperately out of work or seasonal without work 3. Did not do any work -> R20 __ __ __ R18. Industry: Full name of your agency [Dānwèi] (as an organization, department, division, section, etc.): Main products or major business __ __ __ R19. Occupation: The specific work that I have engaged in: -> R23 __ __ __ R20. Reason for not working: 1. Study in school -> R23 2. Disabled 3. Do not have a job after graduation 4. Out of work due to agency [Dānwèi] reasons 5. Out of work due to personal reasons 6. Contracted land for my work was acquired by the government 7. Retired 8. Homemakers 9. Other __ R21. Did you seek for jobs within the past three months? 1. Job seeking at employment or job referral agencies 2. Asked relatives and friends to look for jobs 3. Responded to advertisements or create your own advertisements 4. Participated in the recruitment meetings or job fairs 5. Prepared for self-employment in business 6. Other

7. Has never seek for work __ R22. Ability to work If there is a suitable work for you, can you start to work within two weeks? 1. Yes, I can. Consecutive duration without work _____________ months 2. No, I cannot. __ | __ __ R23. The major source of income 1. Earned income 2. Severance, retirement pension, Social Security payments 3. Unemployment Insurance 4. Social Security subsistence allowances (Supplemental Security Income) 5. Income from property and equity 6. Supported by other family members 7. Other __ R24. Marital status: 1. Single -> R28 2. Married 3. Divorced 4. Widowed __ R25. Marriage (first marriage) date, year and month ______________ Year ___________ Month __ __ __ __ __ __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 64 years old: R26. Number of children born: Gave birth (Live Birth): Number of male ________ Number of female _______ Among the live births, how many are still alive? Number of male ________ Number of female _______ __ | __ __ | __

-------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 50 years old: R27. Child bearing status during period of 2009. 11. 1 - 2010. 10. 31: 1. Did not give birth 2. Gave birth Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ | __ __ | __ If gave birth two or more children within the 12 month period, the situation of the second child are: Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 60 years old or older: R28. Status of physical health: Have four standard answers: 1. Healthy 2. Basically healthy 3. Not healthy, but can live independently 4. Cannot take care of themselves for the daily routines __ (Fifth person) R14. Are you literate? 1. Yes 2. No __ R15. Highest level of education completed: 1. Has never attended school -> R17 2. Primary (elementary) school 3. Middle school

4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ R16. The status of education completion: 1. Currently enrolled in school 2. Graduated 3. Received a certificate of course completion without receiving the degree diploma [Sì yè] 4. Dropout 5. Other __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 15 years old or older: R17. Work status: During 25-31 of October, did you work for more than one hour in order to earn an income? 1. Yes. Number of hours worked last week _________ hours 2. On vacation, in training or studying, temperately out of work or seasonal without work 3. Did not do any work -> R20 __ __ __ R18. Industry: Full name of your agency [Dānwèi] (as an organization, department, division, section, etc.): Main products or major business __ __ __ R19. Occupation: The specific work that I have engaged in: -> R23 __ __ __ R20. Reason for not working: 1. Study in school -> R23 2. Disabled 3. Do not have a job after graduation 4. Out of work due to agency [Dānwèi] reasons 5. Out of work due to personal reasons 6. Contracted land for my work was acquired by the government 7. Retired 8. Homemakers

9. Other __ R21. Did you seek for jobs within the past three months? 1. Job seeking at employment or job referral agencies 2. Asked relatives and friends to look for jobs 3. Responded to advertisements or create your own advertisements 4. Participated in the recruitment meetings or job fairs 5. Prepared for self-employment in business 6. Other 7. Has never seek for work __ R22. Ability to work If there is a suitable work for you, can you start to work within two weeks? 1. Yes, I can. Consecutive duration without work _____________ months 2. No, I cannot. __ | __ __ R23. The major source of income 1. Earned income 2. Severance, retirement pension, Social Security payments 3. Unemployment Insurance 4. Social Security subsistence allowances (Supplemental Security Income) 5. Income from property and equity 6. Supported by other family members 7. Other __ R24. Marital status: 1. Single -> R28 2. Married 3. Divorced 4. Widowed __ R25. Marriage (first marriage) date, year and month ______________ Year ___________ Month __ __ __ __ __ __ --------------------------------------------------------------------------------------------------------------------------------------------------------------------

Complete the following for each woman age 15 to 64 years old: R26. Number of children born: Gave birth (Live Birth): Number of male ________ Number of female _______ Among the live births, how many are still alive? Number of male ________ Number of female _______ __ | __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each woman age 15 to 50 years old: R27. Child bearing status during period of 2009. 11. 1 - 2010. 10. 31: 1. Did not give birth 2. Gave birth Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ | __ __ | __ If gave birth two or more children within the 12 month period, the situation of the second child are: Then month the child was born: Month ____________ The sex of the infant is: 1. Male 2. Female __ __ | __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 60 years old or older: R28. Status of physical health: Have four standard answers: 1. Healthy 2. Basically healthy 3. Not healthy, but can live independently 4. Cannot take care of themselves for the daily routines __ --------------------------------------------------------------------------------------------------------------------------------------------------------------------

Household ID Number: No. _____ __ __ __ Total number of pages for this household ____ __ Page number for this page ______ __ Signature of the reporter _______ Signature of the Census Enumerator ________ Report Date: November __

The Sixth National Population Census Enumeration Form Short Form This Form is approved by the State Council for the Sixth National Population Census Enumeration. The Population Census Enumeration Standard Reference Time Point is set at 0:00 AM on November 1, 2010. The original Population Census data will not be provided to any agency or individual. They are for aggregate use only. Citizens must fulfill their obligations to accurately report the items on the Population Census Enumeration Form. Form Number: R601 Form Form creation Organization: National Bureau of Statistics of China Office of the Sixth National Population Census, the State Council Document Approval Number: National Development (or Guo Fa) [2009] No. 23 Valid until: December 2010 Address of this Household and the Address Code: County [Xiàn], County-level City [Shì] Township [Xiāng], Town [Zhèn] _ City District [Qū] __ __ _______ Street, Road [Jie Dào] __ __ __ ______ Census District [Pǔ chá qū] __ __ __ _____ Census sub-District [Pu chá xiǎo qū] __ __ __ Housing unit ID Number ______ __ __ H1. Household ID Number: No. ____________ __ __ __ H2. Type of Household: 1. Family household 2. Collective quarters __ H3. The number of persons who should be registered in this household: The number of persons who slept in this household at the night of October 31, 2010: _____ persons __ __

The number of persons who have the Household Registration under this household, but did not sleep in this household at the night of October 31, 2010: _____ persons

__ __ H4. 2009. 11. 1 -- 2010. 10. 31: Births: Male ______ persons. Female _________ persons __ __ Deaths: Male ______ persons. Female _________ persons __ __

H5. Building construction area of this housing unit for this household: __________ Square Meters __ __ __ H6. The number of rooms in this housing unit for this household: Number of rooms______________ __ __ ===================================================================================================== Complete the following for each person: (First person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 0. Head of the household 1. Spouse 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __

R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R11 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R10 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home

7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 6 years old or older (Born before October 31, 2004): R11. Are you literate? 1. Yes 2. No __ R12. Highest level of education completed: 1. Has never attended school 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Second person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 1. Spouse 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __

R3. Sex: 1. Male 2. Female __ R4. Date of birth: Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R11 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration:

1. Did not leave the Location of the Household Registration -> R10 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 6 years old or older (Born before October 31, 2004): R11. Are you literate? 1. Yes 2. No __ R12. Highest level of education completed: 1. Has never attended school 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ --------------------------------------------------------------------------------------------------------------------------------------------------------------------

(For households with more than five people, starting from the 2nd page of the Population Census Form, you only need to fills in the "H1. Household ID Number" on the household records) [that is you don't need to repeat H2 to H17]

Complete the following for each person: (Third person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],

Street, Road [Jie Dào]) 4. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 5. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 6. Hong Kong, Macao, Taiwan or in foreign country __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì])

__ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R7. Location of Household Registration: 1. Current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 2. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],

Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R11 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R10 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ --------------------------------------------------------------------------------------------------------------------------------------------------------------------

Complete the following for each person age 6 years old or older (Born before October 31, 2004): R11. Are you literate? 1. Yes 2. No __ R12. Highest level of education completed: 1. Has never attended school 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person: (Fourth person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: Born in: Year _________ Month _______ __ __ __ __

__ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R11 __ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R10 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __

R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 6 years old or older (Born before October 31, 2004): R11. Are you literate? 1. Yes 2. No __ R12. Highest level of education completed: 1. Has never attended school 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person: (Fifth person :) R1. Name: __ __ __ __ R2. Relationship to head of household: 2. Son or daughter 3. Parents 4. Father-in-Law and Mother-in-Law (wife's parents)

Or Father-in-Law and Mother-in-Law (husband's parents) 5. Grand parents 6. Daughter-in-Law or Son-in-Law 7. Grandson or granddaughter 8. Siblings (older brother, younger brother, older sister, younger sister) 9. Others __ R3. Sex: 1. Male 2. Female __ R4. Date of birth: Born in: Year _________ Month _______ __ __ __ __ __ __ R5. Nationality: ____________ Nationality __ __ R6. Place of residence at the Census Standard Reference Time Point: 1. Current Census sub-District 2. Other Census sub-District of the current Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) 3. Other Village Committee [Cun wei huì] (or Neighborhood Committee [Jū wěi huì]) of the current Township [Xiāng] (or Town [Zhèn],


Street, Road [Jie Dào]) 3. Other Township [Xiāng] (or Town [Zhèn], Street, Road [Jie Dào]) of the current County [Xiàn] (or County-level City [Shì], City District [Qū]) 4. Other County [Xiàn] (or County-level City [Shì], City District [Qū]). Please fill in the address below: 5. Household status pending -> R11

__ __ __ ___________________ Province [Shěng] (or Region [Qū], Municipality [Shì]) __ __ ___________________ Prefecture [Di] (or Prefectura- level City [Shì]) __ __ __ ______________ County [Xiàn] (or County-level City [Shì], City District [Qū]) R8. Duration away from the Location of the Household Registration: 1. Did not leave the Location of the Household Registration -> R10 2. Less than half of a year 3. Half of a year to one year 4. One to two years 5. Two to three years 6. Three to four years 7. four to five years 8. five to six years 9. More than six years __ R9. Reason for leaving the Location of the Household Registration: 1. Engage in labor work or conducting business 2. Job transfers 3. Studying, learning and training 4. Family members moving with the job transferee 5. Move to live with relatives or friends 6. Move to a new home 7. Your Household Registration is registered under other household, but you do not live with them [Jì guà hù kǒu] 8. Marriage 9. Other __ R10. Nature (Type) of the Household: 1. Agriculture 2. Non- Agriculture __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Complete the following for each person age 6 years old or older (Born before October 31, 2004): R11. Are you literate? 1. Yes 2. No __ R12. Highest level of education completed:

1. Has never attended school 2. Primary (elementary) school 3. Middle school 4. High School 5. Vocational College 6. University undergraduate 7. Graduate school (Master and doctoral degree) __ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Household ID Number: No. _____ __ __ __ Total number of pages for this household ____ __ Page number for this page ______ __ Signature of the reporter _______ Signature of the Census Enumerator ________ Report Date: November __

1.. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • .~

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经国务院批准进行第六次全国人口普查人口普查的标准时点为2010年11 月 1 日零时人口普查的原始资料不向任何单位和个人提供，仅供汇总使用公民应履行如实申报普查项目的义务

本地址户• 县区、市乡街、道镇蔷区噩军主宅电P

地址码口口口口口口口口口口口口口Hl 户编号 H2. 户卸l H3. 本户应登记人数

1 事庄户2010年10月 31 日晚 y 口在本户， 2010年

居住本户的人数 10月 31 日晚束居住本

号 2 集体户户的人数

人人

口口口口口口口口H4.2009. 11. 1-2010. 10.31

出生人口死亡人口H5 住房用途 H6 本建筑户住面积房

男一一一一人男一一一一人1 生活住房

2 兼作生产提营用房

女人女人 3 无住房(结束) 平方米

口口口口口口口口H7.*户住房间披 H8 建筑层披 H9 承重类型 Hl0 住房建成年代

1.平房 1 铜且铜踊扭捏土 1. 1949年目前

2.2-3品棒房结构 2.1949-1959年

3.1960-1969年3.4-6层楼房 2. 品合结构

4.1970-1979年

间4. 7-9层楼房 3 砖木结构 5.1980-1989年

5. 10屉副主棒房 4 其他结构 6.1990-1999年

7.2000年时后

口口口口口Hll 主要炊事燃料 H12 住管房道内自有来水无 H13 住房内有无厨房 H14 住房内高无厕所

1 鹏气 1 啤立使用 1 植立使用抽水式

2 也 1 有2 与其他户合用 2 合用抽水式

3 煤最 3 矗立使用其他样式2 克 3 品

4 柴草 4，{争用其他样式

5 其他 5 元

口口口口H15 住房内有无洗澡设施 H16 住房来源 H17 月租房费用

1 统一供曲水 1 租霄廉租住房 1. 100元剧下

2 牢是自最热水器2 租肯其他住房 2. 100-200元

3 自建住晶 3. 200-500元

3 其他 4 晌要商品房 4. 500-1000元

5 购买二手房结束 5. 1000-1500元4 元

6 盹罢蛙讲适用房 6. 1500-2000元

7 购买犀品有住房 7. 2000-3000元

8 其他 8. 3000元础上

口口口」 (超过五人的，.，从第2张普查在起，户记录只填写 "H1. i' 属号" )

第六次全国人口普查表长表

每个人部填报

Rl 姓名 R2 豆豆主 R3 刚出生年月 R5 民族 R6 普查时点居住地 R7 户口登记地性别

口。户主 L一----.ßl岁)

在港澳1台或雪国外路3辑 13J FqFhFFlUA& 智红嚣1 配偶1.男

口 : 口2 于女出生于3. :st<菲

口 4. 岳卓品1母基2. 女年

5 租立母月

口口口 6 媳凡其补婿他于单女姐悻革7 8 口口口口口口口口9

口口口口口口口口县(市、区)

口 L一----.ßl岁)

135擒i如 1黯酬1.配偶 1 男

口 : 口2 于女出生于3. 1t母

口 4. ，每1母2 女年

~叶要5. 祖1母月

口口口6 媳畸革

7 孙凡其他于弟姐女悻8 口口口口口口口口9


口 L一----.ßl jI) 1 骂57摇基辅 13黯智红灌1 男

口 : 口2 于女出生于3. :st母

口 4 岳4公1母事2 女

年

5 媳租凡孙蜡1于昂母女姐悻月

口口口6 革7 8 口口口口口口口口9 其他

口口口口口口口口品(市、JiD

口 L一----.ßl岁) 1.本捏其港普他啤查甚台得或(处J市)国且、外剧其，请填- 棋丁面盘地址 1 本E百J 村iZF叫ZE(L居凡占)二委主哩F会R1í'哇明赞14句干F黯四咱4I.Jl

口 j 口2 于女出生于

口3. :st母4. 岳1母

2目女年

或品基5 租立母月

口口口 6 媳凡其补蜻他于单女姐悻革

7. 8 口口口口口口口口,

口口口口口口口口县(市、 JK)

口 L一一〕周岁) 1骂脂辑结 1望寄:在静时1 男2. .f-#()i!o)_.x-i<!'--l!-f:.J.JK . 12

2 于女出生于 3..H (11. llriV *1j>#.()i!o).~ I 3 3. 1t.母 4: 口 4 其户他口待县走(市→、 JK) ，请填写下面地址口

口 4. ，或告叶1母要2 女年 6 港澳台或圄外 R12

5 祖1母月

口口口 6 媳凡其补他畸于单女姐悻革

7 8 口口口口口口口口9


R登8记离地开时户间口 R登g 记离地开原户因口

1 戎有离开户口 1.*"工握商登记地一"'Rll 1 工作调动

2 半年剧下 3. 学习培训3 半年呈一年 4. 随迁事属4 一亘二年

5 挂幸靠在5 二呈三年

6. "1迁撞事6 三呈四年7. 寄挂户口7 四呈五年

8 五呈六年 8. 婚姻埠暑

'六年，，:;.J:. 9. 其他

口口1 世有离开户口 1.*"工蛙商垂记地→R11 1 工作调动

2 半年剧下 1 学导培训3 半年呈一年 4. 随迁草属4 一亘二年5 二呈三年

5.挂幸靠在ι挤去E撞事

6 三亘四年7 四亘五年 7. 寄挂户口

8 五至六年 g 婚姻埠要

9 六年陆上 9. 其他

口口l.iJt有离开户口 1.*"工垣甫登记地→R11 2 工作调动

2 半年时下 3. 学习培训3 半年王一年 4 随迁草属4 一豆二年

5.挂亲靠在5 二亘三年6 三豆四年 6. "1过撞事

7 四豆豆年 7. 寄挂户口

8 豆豆六年 8 婚姻蝉晏

'六年旧上 9. 其他

口口l.iJt有离开户口 1.*"工握商登记地→R11 2 工作调动

2 半年时下 3. 学习培训3 半年呈一年 4. 随迁草属4 一呈二年

1提亲靠在5 二呈三年6 三呈四年 6. "1圣王撞事

7 四豆五年 7. 寄挂户口

8 五亘六年 8. 婚姻埠罄

'六年，，::1....1:. 9. 其他

口口1 唯有离开户口 1.*"工经商登记地→R11 1 工作调动

2 半年剧下 3. 学导培训3 半年王一年 4. 随迁军属4 一亘二年 5.挂幸靠在5 二亘三年6 三呈四年 ι#迁撞事

7. 寄挂户口7 四亘五年8 五至六年 8. 婚姻埠阜

9 六年时上 9. 其他

口口

表号2制定机关z

R 6 0 2 表国家统计局国务院第六次全国人口普查办公室国发 [2009]23 号200 年 1 2 月

批准文号 z有效期至2

登Rl记o地h户粪口型 Rll 性户质口

1.~ 1 在业

2 镇的

居委会 2 非毕业

3 镇的村委会

4 街道

口口1.,

1 毕业

2 镇的居委会 2 非在业

3 镇的

村委会

4 街道

口口1.,

1 在业

2 镇的居委会 2 非扉业

3 镇的村委会

4 街道

口口1.~

1 点业

2 镇的

居委会 2 非在业

3 镇的村委会

4 街道

口口1.,

1 在业

2 镇的居委会 2 非事业

3 镇的

村委会

4 街道

口口

斟上5周的岁人且填报

R12 出生地 R13 五年前常住地

1 本甚市E 2005年11月 1 日

2 本有其他县常1.住省地内• 市区 2 省外 7

3 省外了

省省

口口口口

口口1 本县市区 2常0住05年地11 月 1 日2 本二占其他品

1 省内市E 2 省外了

3 省外:7

有有

口口口口

口口1 本县市区 2常120住省省05年地外内 11 月 1 日2 本:.Ii其他县

市区

3 省外 7 Z

省省

口口口口

口口1 本县市E 2常10住省05地年内11 月 1 日2 本有其他县

市E 2 省外 7 3. ..:画外了

省省

口口口口

口口1.*-品市区 2常10住省05年地内 11 月 1 日2 本二占其他品

市区 2 省外 7 3 省外 7

省有

口口口口

口口」

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~ • • • • • • • • • • • • • • • • • • • • • • • • • • • •

6周岁及以上的人填报

R14 是识字否 R15 受教菌程度 R完16成学情业况

1 未上过学'..... R17 1 在扶1.是 2 小学 2 毕业

3 书中 3 肆业2. 吾

4 高中 4. 辑学

5 大学专科 5. 其他

6 大学本科

7 研克生

口口口1 未上过学'..... R17 1 在枕

1.是 2 小学 2 毕业

3 书中 3 肆业2. 吾

4 高中 4. 辑学


6 大学本科

7 研克生

口口口1 未上过学'..... R17 1 在枕

1.是 2 小学 2 毕业

3 初中 3 蚌业2. 吾

4 高中 4. 辑学


6 大学本科

7 研先生

口口口1 未上过学→R17 1 在枕

1.是 2 小学 2 毕业

3 初中 3 肆业2. 吾

4 高中 4. 辍学


6 大学本科

7 研究生

口口口1 未上过学→R17 1 在校

1.是 2 小学 2 毕业

3 初中 3 肆业2. 否

4 高中 4. 辍学


6 大学本科

7 研先生

口口口

R17 工作情况 R18 行业

10月 25-31 日是否为取得单位详细名称·收λ而工作了一小时时

上

1 是，主用工作时间 7

工2 或在季，耐节唱性歇m 业学一习一、一临小时时停主要产品或主要业~，

3 未做任何工作 • R20

口口口口口口10月 25-31 日是否为取得单位详细名称·性λ而工作了一小时时

上

1 是，主用工作时间 F

工2 或在，季耐节唱性歇掏业学一苟一、一临小时时停主要产品或主要业~，


口口口口口口10月 25-31 日是否为取得单位详细名称-收λ而工作了一小时d

上

1 是，主用工作时间 F

工2 或在，季#节唱性批高业学一导一、一临小时时停主要产品或主要业~，


口口口口口口10月 25-31 日是否为取得单位详细名称-收λ而工作了一小时时

上

1 是，.1:用工作时间 Z

2 在，耐唱高学一司一、一临小时时停主要产品或主要业~，工或季节性歇业3 未做任何工作 • R20

口口口口口口10月 25-31 日是否为取得单位详细名称收λ而工作了一小时d

上

1 是，上用工作时间 F

2 在~耐唱高学一'1一、一临小时时停主要产品或主要业~，工或季节性歇业3 未做任何工作 • R20

口口口口口口

• ~ i'韩号号口口口户共张口

15周岁及以上的人填报

R19 职业 R20 未工作原因R21 三个月内

R22 能否工作是否拢过工作

本人从事的具体 l 在杭学写 ....R23 l 在职业介蜡机构如革有合璋的工工作 2 丧失工作能力→R23 卓取作能否在两周内呻R23 3 毕业后未工作 2 委托幸在找工作

开始工作

4 圄单位犀固且去工作3 血事4刊登广告 1 能

5 因本人届国失去工作4."加招聘会连蠕未工作时间J6 承包土地植征用5. 为自己握营作准备

7 离追悼

8 科理事# 6. 其他一一一个月9 其他 7. 未找过工作 2 不能

口口口口口口 i 口口本人从事的具体 l 在枕学导 ....R23 l 在职业介坦机构如果有合璋的工工作 2 丧失工作能力→123 卓取作能否在两周内呻R23 3 毕业后未工作 2 毒品幸在找工作开始工作

4 固单位犀固失去工作3 血事或刊登广告 1 能

5 因本人犀因失去工作

6 承包土地植和用4."加招聘会连蠕未工作时间J5. 为自己捏营作准备

7 离追悼

8 料理事# 6. 其他一一一个月9 其他 7. 未找过工作 2 不能

口口口口口口 i 口口本人此事的具体 l 在枕学导 ....R23 l 在职业介坦机构如果有合适的工工作 2 丧失工作能力→123 卓职作能否在两周内呻R23 3 毕业后未工作 2 毒品幸在找工作开始工作

4 固单位犀固失去工作3 且在或刊登广告 1 能

5 因本人犀罔生去工作q民加招聘会连蠕未工作时间J6 承包土地拙和用5. 为自己经营作准备

7 离退体

8 料理事# 6. 其他一一一个月9 其他 7. 未找过工作 2 不能

口口口口口口 i 口口本人从事的具体 l 在枕学'1 ~R23 l 在职业介卸机构如果有合璋的工工作 2 丧失工作能力→123 卓职作能否在两周内

• R23 3 毕业后幸工作 2 要品亲友找工作开始工作

4 固单位犀圄失去工作 3. 直在或刊登广告 1 恤

5 圄本人/5.因失去工作

6 承包土地植辑用4."加招聘会连蠕未工作时间;5. 为自己垣营作准备

7 离退体

8 料理事# 6. 其他一一一个月9 其他 7. 卓找过工作 2 不能

口口口口口口 i 口口本人从事的具体 l 在校学导 .....R23 l 在职业介卸机构如果有合茸茸的工工作 2 丧失工作能力→123 卓职作能否在两周内

• R23 3 毕业后幸工作 2 委托亲友找工作开始工作

4 固单位犀圄失去工作 3. 直辛辛或刊登广告 1 能

5 罔本人/5.目失去工作4. 事加招聘会连蠕禾工作时间J6 承包土地战征用5. 为自己捏营作准备

7 离退体

8 料理事# ι其他一一一个月9 其他 7. 未找过工作 2 不能

口口口口口口 i 口口

本张是第张口

15至64周岁的妇女填报 15至50周岁的妇女填报以8上0周的人岁及填报

R23 主要生活R24 婚姻状况 R25 结婚(初婚)每月 R26 生育于女数

R27.2009. 11. 1-2010. 10.31 的 R28 身体健康来源生商状况状况

1 劳动收入 l 未婚呻R28 生育过(活产) 1 永生育 (12个月时内生育 l 健阜2 离退体会鼻老金 2 有配偶

男人2 有生育 E 两个目上孩于崎 2 基本健康

3 失业保陆金 3 离婚年第二个孩于状乱)3. 不健康，但

4 革低生活悻障壶 4 蛊偶女人生育时间是生育时间是生活能自理

5 财产性收入月其中现在存活生生活不能自理

6 牢且其他成员一一一-月一一一-月4英养男人

7 其他女人

婴儿险别是婴儿Ii.别是·

口口口口1 男 1 男

2 女 2 女

口口口口口 i 口口 i 口口 i 口口 i 口口口 i 口口1 劳动收入 l 未婚呻R28 生育过(活产) 1 永生育 (12个月时内生育 l 健康2 离退体企鼻老金 2 有配偶

男人2 有生育 F 两个以上孩于的 2 基本健阜

3 且业悻J陆企 3 离婚年第二个孩于状乱)3. 不健靡，但

4 最低生活悻障企 4 蛊偶女人生育时间是生育时间是生活能自理

5 财产性收入

6 事且其他成员月其中现在存活生生活不能自理

一一一_Jl 一一一-月4英养男人

7 其他女人

思)L 险别是婴儿怯别是


2 女 2 女

口口口口口 i 口口 i 口口 i 口口 i 口口口 i 口口1 劳动收入 l 未婚呻R28 生育过(活产) 1 幸生育 (12个月时内生育 l 健康

2 离退体企鼻老金 2 有配偶男人

2 有生育 Z 两个目上孩于畸 2 基本佳阜3 失业保陆金 3 离婚年第二个孩于状乱)

3. 不健康，但4 最低生活悻障壶 4 丧偶女人生育时间是生育时间是

生活能自理5 财产性收入

月其中现在冉活生生活不能自理6 草庭其他成员一一一_Jl 一一一-月

4英# 男人

7 其他女人

4耳)L 匪别是· 婴儿怯别是


2 女 2 女

口口口口口 i 口口 i 口口 i 口口 i 口口口 i 口口1 劳动收入 l 未婚→R28 生育过(活产) 1 幸生育 (12个月时内生育 l 健阜

2 离退体企鼻老金 2 有配偶男人

2 有生育 F 两个副主孩于的 2 基本健扉3 失业悻陆企 3 离婚年第二个孩于状乱)

3. 不健靡，但4 最低生活悻障壶 4 蛊偶女人生育时间是生育时间是


6 事庭其他成员月其中现在存活生生活不能自理

一一一-月一一一-月4要# 男人

7 其他女人

婴儿怯别是· 婴儿障别是


2 女 2 女

口口口口口 i 口口 i 口口 i 口口 i 口口口 i 口口1 劳动收入 l 未婚→R28 生育过(活产) 1 幸生育 (12个月时内生育 l 健扉

2 离退体企鼻老企 2 有配偶男人

2 有生育 Z 两个刷上孩于崎 2 基本健康3目且且k保险金 3 离婚年第二个孩于收乱)

3. 不健雇，但4 最低生活悻障企 4 蛊偶女人生育时间是. 生育时间是


月其中现在存活生生活不能自理6 草庭其他成员一一一-月一一一λ供# 男人

7 其他女人

婴儿怯别是· 婴儿障别是


2 女 2 女

口口口口口 i 口口 i 口口 i 口口 i 口口口 i 口口

申报人(甚字) 普查M (盛宇) , 填报曰期 11 月日 ~ .

the sixth national population census enumeration form …

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