Household Information
| Grama Niladari Wasama | |
| Household Reference | |
| Applicants Name | |
| Applicants Identity |
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| Address | |
| Selected Category | |
| Appeals |
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| Objections |
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| Bank Account status |
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| Bank Account |
| Bank |
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| Branch |
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| Account NO |
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| Account Name |
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| Payable Status |
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01. Family
| H.H No: |
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| Name: |
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| Address: |
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| 1.1 No of Members: |
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02. Education
| 2.1. Number of Family Member Not Having Passed O/L: |
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| 2.2. Number of Children (5-16 Yrs) Not Going to School: |
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03. Health
| 3.1. Number of family members suffering from long term diseases: |
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| 3.2. Number of family members suffering from a disability: |
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| 3.3. Number of family members suffering from CKDU: |
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04. Economic Level
| 4.1. Monthly Family Expenditure: |
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| 4.2. Monthly Family Income: |
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| 4.3. Average Monthly Electricity Consumption: |
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06. Livestock
| 6.1. Ownership of at least one livestock : |
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05. Assets
| 5.1. Ownership of the resident house and land: |
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| 5.2. Ownership of the other House / Building: |
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| 5.3. Ownership of the High lands: |
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| 5.4. Ownership of the paddy land: |
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| 5.5. Ownership of the Vehicle: |
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| 5.6. Ownership of the machines: |
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07. Housing
| 7.1. Type of Housing : |
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| 7.2. Nature of the House : |
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| 7.3. Size of the floor area : |
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| 7.4. Main source of the drinking water : |
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08. Sanitation And Lighting
| 8.1. If toilet facility in Improved : |
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| 8.2. Type of the Toilet : |
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| 8.3. Main Source of Lighting : |
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09. Family Demography
| 9.1. How many Dependents in your family : |
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| 9.2. Family Unit consisting of only mother of father : |
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| 9.3. How many members in over 70 : |
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