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QUESTIONNAIRE

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
DEMOGRAPHICS
1

HOW OLD ARE YOU?

2

MARITAL STATUS

Select one or more answers
3

NUMBER OF CHILDREN

4

RELIGION

5

PREGNANCY STATUS

Select one or more answers
6

EDUCATION LEVEL

Select one or more answers
7

OCCUPATION

DEMOGRAPHICS