| Name (optional): |
| Age: |
| Gender: |
| Male |
| Female |
| Religion: |
| Education: |
| Illiterate |
| Can read and write |
| Primary |
| Secondary (grade VIII) |
| Grade 10 |
| Higher secondary |
| Graduate |
| Postgraduate |
| Marital Status: |
| Married |
| Unmarried |
| Occupation: |
| Private Job |
| Government job |
| Self-employed |
| Retired |