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Name:

Age:

Annual family
income
Below 1 lakh
O
1 to 2.5 lakhs
O
2.5 to 5 lakhs
5 to 10 lakhs
10 to 20 lakhs
Above 20 lakhs

O
O
O
O

Marital
Status

Educational qualification
Below 10th Grade
th

Below 12 grade
Graduate
Post graduate
Professional
Doctoral level

On an average, how many hours


per day do you spend on the
following activities?
Watching television
Using Internet (non-work
related)
Using Internet (work related)
Reading
Grooming
Where do you
Fitness & related activities
stay?
Household chores
Own house
Shopping
Rented house
Caring for children
Employer provided
accommodation
Hobbies
Ancestral home
Personal activities
Social activities (e.g. clubs,
groups)

O
O
O
O
O
O

Single

Married

Occupation
Professional
Student
Salaried non managerial
Salaried managerial
Self-employed
Not working currently

O
O
O
O
O
O

On an average, how many hours do


you work per day (either working
outside the home or at a home-based
business)?
I dont work outside the home or at a
home-based business
Less than 2 hours
2 to 4 hours
4 to 6 hours
6 to 8 hours
Over 8 hours per day

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