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2012
December
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Name:
*
Email Id:
*
Mobile Number:
*
City:
Gender:
Age:
Which of the following categories best describes your Annual House Hold income?
Under 5,00,000
Rs.5,00,001 - Rs.10,00,000
Rs.10,00,001 - Rs.15,00,000
Rs.15,00,001 - Rs.20,00,000
Rs.20,00,001 - Rs.25,00,000
Rs.25,00,001 or more
What is your current employment status?
Employed full-time
Employed part-time (less than 32 hours)
Retired/unable to work/disabled
Student/ at school
Not working/looking for work
Housewife/househusband
Are you a
-- Select --
ITDM
BDM
Other
What is the highest level of education you have received?
Literate but no formal education
School - upto 4 years
School - 5-9 years
School - SSC/HSC
Some College but not a graduate
Graduate/Post graduate – General
Graduate/Post graduate – Professional
Would you like to share your friend's mail id with us So we can invite them in our upcoming surveys?
Ref. Mail id1:
Ref. Mail id2:
Ref. Mail id3:
Ref. Mail id4:
Thank you for your time.
Best Regards,
Communityview Team
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