| No.of Schedule |
Road, Street and No or Name of house |
Inhabited, Uninhabited (U.) or Building (B.) |
Name and Surname of each Person |
Relation to Head of Family |
Condition |
Age M |
Age F |
Rank, Profession or Occupation |
Where Born |
Whether
1. Deaf -and-dumb
2. Blind
3. Imbecile or Idiot
4. Lunatic |