For Optimum Accuracy, Please Print Carefully USE ONLY 2B .

etc.90306,,Period Codes: 1 Daily2 Weekly3 Fortnightly4 Monthly5 Quarterly6 Semi Annually7 AnnuallyPage 14

SECTION 5 - COMMUNICATION, EDUCATION, RECREATION AND MISCELLANEOUS CONT'DHave you purchased or received any of the following items or services?COMMUNICATION, EDUCATION,RECREATION AND MISCELLANEOUSCODEQTYBOUGHTTOTAL COST( )REGULARITY OFPURCHASE61969FREQUENCYQTYRECEIVEDTOTAL COST( )PERIODEducation and RecreationCinema90101,,Other Recreational and CulturalActivities90102,,Exercise Books90103,,Diaries, Receipt Books, Binders, etc.90104,,School Fees (Tuition)90105,,Other Fees (Tuition)90106,,Professional Fees (e.g. Membership)90107,,Printed Books, Booklets and Leaflets90108,,Newspapers Journals and Periodicals90109,,Picture Postcards and Greeting Cards90110,,Toys - Other90111,,Christmas Decorations90112,,Period Codes: 1 Daily2 Weekly3 Fortnightly4 Monthly5 Quarterly6 Semi Annually7 AnnuallyPage 15

SECTION 5 - COMMUNICATION, EDUCATION, RECREATION AND MISCELLANEOUS CONT'DHave you purchased or received any of the following items or services?COMMUNICATION, EDUCATION,RECREATION AND MISCELLANEOUSCODEQTYBOUGHTTOTAL COST( )REGULARITY OFPURCHASE61969FREQUENCYQTYRECEIVEDTOTAL COST( )PERIODRental of Video Tapes / DVDs90113,,Micro-Computer / Laptops90114,,Computer Peripherals90115,,MISCELLANEOUSTV Subscription90401,,Hotel Accommodation - Vacation90402,,Life Insurance90403,,Medical Insurance90404,,Purchase of Property (Real Estate)90405,,Architectural stic Services90409,,Period Codes: 1 Daily2 Weekly3 Fortnightly4 Monthly5 Quarterly6 Semi Annually7 AnnuallyPage 16

SECTION 5 - COMMUNICATION, EDUCATION, RECREATION AND MISCELLANEOUS CONT'DHave you purchased or received any of the following items or services?COMMUNICATION, EDUCATION,RECREATION AND MISCELLANEOUSCODEQTYBOUGHTTOTAL COST( )REGULARITY OFPURCHASEFREQUENCYBarberQTYRECEIVEDTOTAL COST( )PERIOD90410,,Beauty Shop90411,,Funerals90412,,Public Health or SanitaryServices90413,,Laundry90414,,Land Surveying90415,,Weddings90416,,Legal Fees90417,,2 Weekly3 Fortnightly4 Monthly5 Quarterly6 Semi Annually7 Annually61969Period Codes: 1 DailyPage 17

SECTION 6 - MEALS BOUGHT AWAY FROM HOMEHave you purchased or received any meals away from home?MEALS PURCHASED AWAY FROM HOMECODEQTYBOUGHTTOTAL COST( )REGULARITY OFPURCHASEFREQUENCYQTYRECEIVEDTOTAL COST( Other Meals (Specify)11104,,2 Weekly3 Fortnightly4 Monthly5 Quarterly6 Semi Annually7 Annually61969Period Codes: 1 DailyPage 18

SECTION 7 - PERSONAL GIFTSPART A: RECEIVED FROM OUTSIDERSDid you receive any personal gifts from persons outside of your household during the last twelve (12)months ?RECEIVEDCODEDESCRIPTION OF ITEMOFFICIAL USE ONLYQTYRECEIVEDYesNo Go to Page 20ESTIMATED TOTALCOST( ),,,,,,,,,,,61969,,Page 19

SECTION 7 - PERSONAL GIFTS (CONT'D)PART B: GIVEN TO OUTSIDERSDid you give any personal gifts to persons outside of your household during the last twelve (12) months?GIVENDESCRIPTION OF ITEMCODEQTYGIVENYesNo Go to Page 21ESTIMATED TOTALCOST( )OFFICIAL USE ONLY,,,,,,,,,,61969,,Page 20

SECTION 7.1 - PET AND ANIMAL SUPPLIES1. Did you purchase or received as a gift, any pets or live stock (e.g. sheep, cats, dogs, birds, etc.) during thelast twelve (12) months?YesNo Go to Page 22RECEIVEDDESCRIPTION OF PET OR LIVESTOCKCODEQTYTOTAL COST( )OFFICIAL USE ONLY,,,,,,,,,,61969,,,Page 21

SECTION 7.1 - PET AND ANIMAL SUPPLIES CONT'D2. Did you purchase or received as a gift, any pet care items or supplies (e.g. pet food, feed, chew toys, vaccine shots,etc.) during the last twelve (12) months?YesNo Go to Page 23RECEIVEDDESCRIPTION OF ANIMAL SUPPLIESCODEQTYTOTAL COST( )OFFICIAL USE ONLY,,,,,,,,,,61969,,,Page 22

SECTION 8 - INDIVIDUAL INCOMEWhat are your main sources of income and how much do you obtain from these sources?SOURCES OF INCOME (ANNUAL)INCOMEREGULARITYFREQUENCY619691. Wage or salary incash2. Wage or salary in kind (goods/servicesgiven free of charge by employer eg.uniforms, transportation, housingSOURCES OF INCOME (ANNUAL)INCOMEFREQUENCYPERIOD,11. Unemployment Benefit,,12. Subsidies from Government (Rent,water),,13. Regular gift from persons inBarbados, excluding gifts from householdmembers,4. For Self Employed, Net Earnings,14. Pension from overseas,5. For Self Employed, % of Outputconsumed by household,15. Regular gifts from overseas in cashor kind,6. Income from secondary occupationafter compulsory deductions,16. Rents, interest from savings,dividends,7. Directors fees (Board ofdirectors fees/payments),17. Income received from lodgers andboarders after deduction of cost,8. Old-Age Pensions fromGovernment in cash,18. Other income received regularly,9. Govenment assistance to persons under65 in cash (eg. destitue, disabled etc),10. Govenment assistance to persons under65 in kind (eg. clothing, dentures, spectacles),3. Tips, bonuses, commissions,allowances, gratuitiesPeriod Codes: 1 Daily2 Weekly3 Fortnightly4 MonthlyREGULARITY5 Quarterly6 Semi AnnuallyPERIOD7 AnnuallyPage 23

61969COMMENTSPage 24

HOMEMADE REGULARITY OF . Hair Dye Shampoo Toothpaste Perfumes and Toilet Waters Cosmetics and other such products Manicure Preparations Hair Relaxer, Straightener, etc. Moth Balls Toilet Soap (cakes) Medicated Soap Toilet Paper Have you purchased or received any of the following items or services?