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2014
January
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Name
Age
Gender
Male
Female
Contact Details (Telephone no./Locality) :
Religion
Hindu
Muslim
Christian
Sikh
Jain
Jew
Other
Caste :
What is your age-group?
13-19
20-24
25-34
35-44
45-54
55 or above
Are you married?
Yes
No
How many members are there in your family?
2
3
4
5
6 or more
How many children do you have, if any?
1
2
3
4 or more
How many children do you have, if any?
1
2
3
4 or more
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