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Questions marked with a * are required Exit Survey
 
 
* 1. Date of survey
MonthDayYear
  
 
 
 
* 2. State
 
Andaman and Nicobar
 
Andhra Pradesh
 
Arunachal Pradesh
 
Assam
 
Bihar
 
Chandigarh
 
Chhattisgarh
 
Dadra and Nagar Haveli
 
Daman and Diu
 
Delhi
 
Goa
 
Gujarat
 
Haryana
 
Himachal Pradesh
 
Jammu and Kashmir
 
Jharkhand
 
Karnataka
 
Kerala
 
Lakshadweep
 
Madhya Pradesh
 
Maharashtra
 
Manipur
 
Meghalaya
 
Mizoram
 
Nagaland
 
Orissa
 
Punjab
 
Puducherry
 
Rajasthan
 
Sikkim
 
Tamil Nadu
 
Telangana
 
Tripura
 
Uttar Pradesh
 
Uttarakhand
 
West Bengal
 
 
 
* 3. Occupation?
 
Defence
 
Retired
 
Disabled

 
 
 
* 4. Should show only if disabled is chosen
 
Physical
 
Mental
 
Other

 
 
 
5. Random 123
 
1
 
2
 
3
 
 
 
* 6. Should show only if Andaman + Defence is chosen
 
1
 
2
 
3
 
 
 
* 7. What is the dispute about?
Land
Family
IP
Crime
 
 
 
* 8. If crime, what crime?
Against property
Hurt
Sexual violence
SC/ST atrocities