(1) AGE: _____________________
(2) SEX: M / F
(3) MARITAL STATUS: M / S / D / F
(4) OCCUPATION: __________________ (5) FULL TIME/ PART TIME
(6) INCOME FREQUENCY: Weekly Fortnightly Monthly Otherwise
(8) Do you have any sources of income? _________________________HOUSE
(9) What type of house do you own?
(a) Wooden (b) Concrete ( c) Wooden/Concrete (d) Other: __________
(10) How many rooms are in the house?
(a) 1 Room (b) 2 Rooms ( c) 3 Rooms (d) More: ______
(11) Who owns the house?
(a) Self (b) Family (c ) Friend (d) Other (specify): _____________
(12) Is the house insured?
Yes / No
(13) How many persons live in the house?
(a) 3 (b) 4 - 6 (c ) 7 - 9
(14) How many in the household work? ______________HOUSE OWNERS
(15) How was the house constructed?
(a) Contractor (b) Workers (c ) Self-Help (d) Other: ______________
(16) How much did your house cost to constructed?
(a) Under 20,000 (b) 20,001 - 40,000 (c ) Over 40,000
(17) Has your house ever been struck by hurricane? Yes / No
(18) If yes, what section was damaged?
(a) Roof (b) Walls (c) Other
(19) How would you rate house safety during a hurricane?
(a) Unsafe (b) Slightly Safe (c) Safe (d) Very Safe
(20) Can the house be made Safe? Yes / No
(21) If yes, how? Reinforcing Roof / Other _________________
(22) What are the major constraints in making your house safer?
(a) Money (b) Contractor (c) Time (d) Other: _____________
(23) If loans were available at any of the following would you accept?
(a) Credit Unions (b) Banks (c) National Development Foundation (d) Others: ________
(24) If loans were available, what type of loan would you like?
(1) Size: (a) Under 1000 (b) 1001-2000 (c) 2001-3000
(2) Duration: (a) Under 6 mths (b) 7 mths - 12 mths (c) 13 mths-18 mths (d) Above 18 mths
(3) Security: (a) Cash (b) Guarantor (c) Bill of Sale (d) Other: ____________
(25) Would you be interested in loans for repairs of other sections of your house? Yes / No
(26) If yes, which sections?
(a) Foundation (b) Walls (c) Other: __________
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Page Last Updated: 20 April 2001