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SUSENAS VSEN99.MREPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS1999 NATIONAL SOCIO-ECONOMIC SURVEY
LISTING OF CONSUMPTION / HOUSEHOLD EXPENDITURES
CONFINDENTIALI. LOCATION IDENTIFICATION III. ENUMERATION PARTICULARS
01 Province 01 Name and NIPof enumerator02 District/municipality*)03 Sub-district04 Village /Village Unit*)05 Area 1. Urban
2. Rural
02 Enumerator ‘s occupation Provincial staff 1District/municipality 2staffSub-district staff 3Partner 4
06 Enumeration area number 03 Date of enumeration07 Segments group number 04 Enumerator’s signature08 Segment number09 Sample code number
05 Name and NIP of supervisor
10 Sample serial number of household 06 Supervisor’s Position Province KS staff 1District/municipality 2KS staffMantis 3
07 Date of supervision Serial number
11 Village classification 1. Leastdeveloped village
2. Developedvillage
Filled in byeditor
08 Supervisor’s signature
II. HOUSEHOLD CHARACTERISTICS01 Name of household head
03 Name & serial number of respondent
02 Number of household members 04 Address (street/lane name, RT/RW)
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IV. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
001 A. Cereals002 Rice (local, high quality, imported) Kg003 Glutinous rice Kg004 Wet corn with skin Kg005 Dry-shelled corn/corn-rice Kg006 Rice flour Kg007 Corn flour (maizena) Kg008 Wheat flour Kg009 Others ………………. Kg
010 B. Tuber Kg011 Cassava Kg012 Sweet potato Kg013 Sago (not made of cassava, Kg
Example: ‘Ambon” sago)014 Taro Kg015 Potato Kg016 Dried cassava Kg017 Dried-cassava flour Kg
5
6
IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
018 Cassava flour (Tapioca) Kg019 Others …………………… Kg
020 C. Fish1] Fresh fish
021 Yellow tail fish Kg022 Tuna Kg023 “Tenggiri” fish Kg024 “Selar” fish Kg025 “Kembung” fish Kg026 “Teri” Kg027 “Bandeng” fish Kg028 “Gabus” fish Kg029 Tilapia fish Kg030 Gold fish Kg031 Cat fish Kg
7
8
III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
032 Snapper fish Kg033 “Baronang” Kg034 Others ………………. Kg
2] Shrimp and other fresh seafoods035 Shrimp Kg036 Squid Kg037 Crab Kg038 Shell/snail Kg039 Other ………………. Kg
3] Preserved fish040 “Kembung” fish Ounce041 “Tenggiri” fish Ounce042 Tuna fish Ounce043 “Teri” Ounce044 “Selar” fish Ounce045 “Sepat” fish Ounce
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10
IV. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
046 “Bandeng” fish Ounce047 “Gabus” fish Ounce048 Canned fish Ounce049 Others ………………. Ounce
4] Shrimp and other preservedseafoods
050 Shrimp (Dried shrimp) Ounce051 Squid Ounce052 Other ………………. Ounce
053 D. Meat1] Fresh meat
054 Beef Kg055 Buffalo Kg056 Goat Kg057 Pork Kg058 Purebred chicken Kg059 Free range chicken Kg
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
060 Other poultry meats …………..(state……………………………)
Kg
061 Other meats ……………….. Kg
2] Preserved meats062 Dried meat Kg063 Dried shredded meat Ounce064 Canned meat Kg065 Others ………………. Kg
3] Other066 Liver Kg067 Innards (other than liver) Kg068 “Tetelan” (bones with a bit of
adhering meat)Kg
069 Bones Kg070 Others ……………….
071 E. Eggs and milk072 Egg of purebred chicken Kg
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
073 Egg of free range chicken Pieces074 Duck egg Pieces075 Quail egg Pieces076 Other eggs Pieces077 Salted egg Pieces078 Pure milk Liter079 Dairy milk 250ml *)080 Sweetened condensed milk 397gr **)081 Powdered milk Kg082 Baby powder milk 400gr ***)083 Cheese Ounce084 Other dairy products: ……………. Ounce
085 F. Vegetables086 Spinach Kg087 Water spinach Kg088 Cabbage Kg*) Boxes**) Small can***) Small can
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
089 Chinese cabbage/ white mustard(“petsai”)
Kg
090 Green mustard Kg091 String bean Kg092 Green beans Kg093 Tomato Ounce094 Carrot Kg095 Cucumber Kg096 Leaves of cassava Kg097 Eggplant Kg098 Soya bean sprouts Kg099 Squash Kg100 Baby corn Ounce101 Vegetables soup/stir-fried
vegetablesPackage
102 “Sayur asam” (sour soup) Package103 Jack fruit, ripening Kg104 Papaya, ripening Kg105 Mushroom Ounce
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
106 “Petai” (beans with pungent odor) Ounce107 “Jengkol” (Phithecolobium) Kg108 Shallot Ounce109 Garlic Ounce110 Red chili Ounce111 Green chili Ounce112 Small chili Ounce113 Canned vegetables Kg114 Others …………….. Kg
115 G. Pulses116 Peanut without skin Kg117 Peanut with skin Kg118 Soy bean Kg119 Mungbean Kg120 Cashew nut Ounce121 Other peanuts Kg
(………………..)
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
122 Tofu Kg123 Fermented soy bean cake/tempe Kg124 Fermented soy bean sauce Ounce125 Oncom (fermented soybean
sediment cakeOunce
126 Others …………………. Ounce
127 H. Fruits128 Orange Kg129 Mango Kg130 Apple Kg131 Avocado Kg132 “Rambutan” Kg133 Lanzon Kg134 Durian Kg135 Snake fruit Kg136 Pineapple Kg137 ‘Ambon’ Banana Kg
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
138 King “Raja” banana Kg139 Other bananas Kg
……………………140 Papaya Kg141 Rose-apple/guava Kg142 “Sawo” (Sapodilla) Kg143 Star fruits Kg144 “Kedondong” Kg145 Watermelon Kg146 Melon Kg147 Jack fruit Kg148 Tomato Kg149 Canned fruits Kg150 Others ……………….. Kg
151 I. Oil and fat152 Coconut oil Liter153 Corn oil Liter
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
154 Other cooking oil: Liter155 Coconut pieces156 Margarine/Butter Ounce157 Others
……………………..158 J. Beverages159 Granulated sugar Ounce160 Palm sugar Ounce161 Tea Ounce162 Coffee (ground, beans, instant) Ounce163 Instant cocoa 150 gram164 Powdered cocoa Ounce165 Syrup 620ml*)166 Others ……………….
167 K. Spices168 Salt Ounce169 Candle nuts Ounce*) Large bottle
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
170 Coriander/caraway seed Ounce171 Pepper Ounce172 Tamarind Ounce173 Nutmeg Ounce174 Clove Ounce175 Fish paste Ounce176 Soy sauce 140 ml *)177 Monosodium glutamate Gram178 “Sambal” (chili sauce) /tomato
sauce140 ml*)
179 Prepared spices/package Ounce180 Other cooking spices
…………………….181 L. Other consumables182 Fish/Shrimp crackers Ounce183 Emping chips Ounce184 Wet noodle Kg185 Instant noodle 80 gr**)*) Small plastic bottle**) One regular packages
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
186 Rice noodle Ounce187 Macaroni/ dried noodle Ounce188 Jelly Pack (7 gr)189 Baby food (packaged) 150 gr*)190 Others
………………………..191 M. Prepared foods & drinks
(taken from VSEN99.LPK)192 White Bread Small pack193 Sweet bread/other bread Piece194 Dry cake/Biscuit/’semprong’ Ounce195 Wet cake Piece196 Fried food Piece197 Mungbean porridge Bowl198 Gado-gado/’ketoprak/’pecel’ Plate199 A Plate of rice and side dish (rames) Plate200 Fried rice Plate201 Rice Plate*) Small pack
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
202 “Lontong” (rice steamed in bananaleaf)/ Ketupat sayur (kind ofLontong with vegetables)
Bowl
203 “Soto”/goulash/soup/”rawon”/mince
Bowl
204 “Sate” /”Tongseng” (kind of lambgoulash)
Plate/ 5 stick
205 Meat ball noodle soup/boilednoodle/fried noodle
Bowl
206 Instant noodle Bowl207 Snack for kids/crisp/crispy chip Ounce208 Fish (fried, baked, fermented,
steam, preserved, etc)Piece
209 Chicken/meat (fried, baked, etc) Piece210 Ice cream Small bowl211 Other ice …………… Glass 200ml212 Other prepared foods ……………..213 Soft drink with CO2 (soda) 200 ml *)
Beverages without CO2:
214 Packaged water 500 ml **)215 Packaged tea drink 200 ml ***) *) Small Glass Bottle **) Small Plastic Bottle***) “Tea bottle” packaging
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IV. 1. FOOD, BEVERAGES, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase
(cash/owed)Own production,
given, etc.Total of consumptionSeri
alnumber
Details Standard unit Total
(0,00)
Value
(Rp)
Total
(0,00)
Value
(Rp)
Total(4) + (6)(0,00)
Value(5) + (7)
(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)
216 Fruit juice (packaged) 200 ml*)217 Health drink/energy drinks 100 ml**)218 Other drinks (coffee, coffee milk,
tea, chocolate milk)Glass
219 N. Alcoholic beverages220 Beer 620 ml***)221 Wine 620 ml***)222 Other alcoholic beverages ………. 620 ml***)
………………..223 O. Tobacco and betel224 Filtered clove cigarette piece225 Unfiltered clove cigarette piece226 White tobacco Cigarette piece227 Tobacco Ounce228 Betel leaves/areca nut229 Other …………………..*) Package in a box**) Small bottle***) Large bottle
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)230
231
A. Housing and Household facility
The house you are living is:Own property/free of rent 1 Rent purchased/installment 4Lease 2 Official house 5Rent 3 Other 6
232 If the house is own property/free of rent, estimation monthly renting: Rp. ………………….
233 If the house is leased:
a. Lease agreement: ……………….yearsb. Lease value: Rp. …………………..c. Average monthly lease value: Rp. …………
234 If the house is rented, monthly rent value: Rp. ………….
235 If the status of housing is purchase-rent (installment), official and others, average value of monthly rent:Rp. ……………
236 Maintenance costs of the house (paint, plastering, painting the wall, roof, window glass, hinge, etc, includingwages for the workers)
237
238
Electricity:
Electricity use (quantity): a. A month ago: …….………..kwh/watt *)b. 12 months ago: …………….kwh/watt *)
Note: If household doesn’t know KwH unit (for example: Non-PLN user), calculate as below:Number of watt used x number of electricity hours used monthly divided 1000
Value:
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)239 Telephone240
241
Water (“PAM” = Municipal Water Corporation / water vendor/ purchased)Quantity: a. A month ago: ……………………m3
b. 12 months ago: ………………….m3
Value:242
243
LPG (Liquid Propane Gas)Quantity: a. A month ago: ……………………kg
b. 12 months ago: ………………….kg
Value244
245
City GasQuantity: a. A month ago: ……………………m3
b. 12 months ago: ………………….m3
Value:246
247
KeroseneQuantity: a. A month ago: ……………………liter
b. 12 months ago: ………………….liter
Value248
249
Generator
a. Type and amount of fuel used:
Gasoline 1 Kerosene 3 A month ago: ……………..literSolar 2 12 months ago: ……………liter
Value
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)250
251
252
b. Lubricant oil:
Quantity: a. A month ago: ……………………literb. 12 months ago: ………………….liter
Value:
c. Maintenance and repair253
254
Charcoal
Quantity: a. A month ago: ……………………kgb. 12 months ago: ………………….kg
Value255 Firewood and other fuel
256 Others (flashlight, storage battery, matches, mosquito repellent, lamp, air freshener, Liquid floor cleaner, etc)
257
258
B. Goods and Services
Bathing soap, toothpaste, toothbrush, and shampoo
259 Cosmetics (perfume, pomade, deodorant, powder, nail clippers, lipstick, comb, etc), and sanitary napkin
260 Treatments: skin, face, nails, hair (cost for cut, curl, creambath), ‘lulur’ (herbal skin exfoliation, etc)
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)
261262263264265266267268269270271
Health
Government hospitalPrivate hospitalDoctor’s practicePuskesmas (Integrated Health Center)Supporting PuskesmasClinic/”Mother and Child’s Clinic”/Health Clinic “BP”Posyandu (Integrated Health Services Post)/CadreMidwife/paramedic/practice nursesTraditional healer/Shinshe (Chinese traditional healer)Purchased medicine with doctor’s prescriptionSelf-treated/purchased medicine without doctor’s prescription/purchased medicinal herbs
272273274275
Other health:
Pregnancy examination costDelivery costImmunization cost for children under 5 yearsCheck-up and contraceptive costs
276 Health treatment (vitamin, herbs, massage, fitness, etc)
277278279280281282
School & course expenses
Donation for school development (enrollment fee)School tuition (SPP) and BP3/POMG contributionOther school contribution (vocational skills classes, additional lessons, exams, etc.)Textbooks/photo copy of textbooksStationeries (calculator, compass, etc)Course fees
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)283 Newspapers, magazines, books, and stationery (excluding school and course needs) including rent of
magazines/literatures
284 Postage, Telegram, public phone, and post materials, including pager fees
285
286
287
288
289
290
Motor vehicle fuel used for household needs (not for business/work)
a. GasolineQuantity: (1) A month ago: ………………………….liter
(2) 12 months ago: ………………………..liter Value:
b. Solar fuelQuantity: (1) A month ago: ………………………….liter
(2) 12 months ago: ………………………..liter Value:
c. Lubricant oilQuantity: (1) A month ago: ………………………….liter
(2) 12 months ago: ………………………..liter Value:
291 Maintenance and repairs of motor vehicle (brake oil, water for car battery, car battery, etc)
292 Costs of transportation (bus, train, airline, ship, ‘becak’ (pedicab), parking fee, toll fee, etc)
293 Hotel, motel, cinema, theatre, sport, decoder, and other recreations, (excluding transportation cost and purchaseof goods for recreation)
294 Servant and driver (wages or salary)
295 Other goods (tissue, camphor, banana leaves, coconut leaves, stick for ‘sate’, etc)
296 Other services (Identity card, Driver’s license, birth certificate, photo copy, photo, etc)
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)297
298
C. Clothing, Footwear, and Head gear
Ready made men’s wear (Blazer, long-sleeved shirt, Jacket, sarong, pants, T-shirt, underwear, etc)299 Ready made women’s wear (Gown, long fabric, blouse, house dress, sweater, skirt, sarong, shawl, cloth girdle,
underwear, etc)300 Ready made children’s wear (clothes, pants, sweater, shirts, under wear, baby napkin, etc)
301 Materials/fabrics for men, women, and children (wool, polyester, cotton, silk, etc)
302 Tailoring and repair costs, thread, and sewing needs
303 Footwear for men (shoes, sandal, sock, etc)
304 Footwear for women (slippers, shoes, sandal, etc)
305 Footwear for children
306 Head gear for men, women and children (hat, ‘kopiah” =rimless cap, veil, etc)
307 Laundry-soap (in bar form, powder, cream, and liquid)
308 Clothes maintenance products (Softener, whitener, starch and similar items)
309 Others (towel, belt, shoe polish, tie, laundry, small hanger, etc)
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)310
311
D. Durable goods
Furniture ( table, chair, bed, wardrobe, showcase, long-shelf, mirror, kitchen cabinet, baby bed, etc)312 Household equipment (sewing machine, refrigerator, fan, washing machine, air conditioner, etc)
313 Household utensils (mattress, pillow, table cloth, bed sheet, ashtray, pillow sheet, blanket, plaited mat, curtain,carpet, etc)
314 Household tools (Iron, broom, scissors, knife, machete, saw, vacuum cleaner, hanger, soldering tools, etc)
315 Kitchen/eating utensils (plate rack, stove, cooking pot, pan, pail, wok, spoon, thermos bottle, plate, glass,mixer, blender, microwave, oven and other utensils made of glass, ceramic, melamine, and plastic)
316 Decorative items(wall decoration, aquarium, decoration goods made of ceramic, porcelain, onyx, marble,wood, etc)
317 Repair of household equipment, utensils, tools
318 Watch, clock, camera, glasses, video camera, other optic tools and their repair
319 Umbrella, bag, luggage, and their repair
320 Expensive jewelers made of metal and gold (gold, diamond, pearl, etc) and their repair
321 Children’s toys and their repair
322 Television, video, radio, cassette, radio cassette, guitar, piano/organ, computer, and their repair
323 Sporting goods (chess, racket, ball, net, bet, stick, including swim trunk, shoes for playing soccer/roller shoes,glasses for swimming, etc) and their repair
324 Vehicle (bicycle, motor cycle, car, etc) and large repairs
325 Pets and plants including the maintenance expenses
326 Other durable goods (cradle, baby carriage, electricity installation, telephone, pipe, pager, and their repair)
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IV. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahSeri
alNO.
DETAILA month ago 12 month ago
(1) (2) (3) (4)327
328
E. Taxes and insurance:
Building and Land tax (PBB)329 Radio & TV tax, and its type
330 Vehicle (motor and non motor) tax
331 Other taxes/levies (community, garbage, security, cemetery, etc)
332 Accident & loss, and health insurance
333
334
F. Festivities and ceremonies
Wedding (rent of equipment such as wedding equipments, chairs, tents, plates, etc and services such as bride’smake-up, person officiating wedding, and function hall rental, etc)
335 Circumcision, birthday (expenses for professional circumcizer, doctor/paramedics/traditional circumcizer,balloon, boxed food, ribbon/paper for decoration, chairs, hall rental & entertainment costs).
336 Religious festivals (‘Qurban’, offering, etc)
337 Haj expenses
338 Other traditional ceremonies (invite “ustadz”, Priest, make offering, etc)
339 Burial expenses (cost of bathing the body, material to cover the body, for digging the soil, coffin, cost ofcrematorium, cost of ‘ngaben’ (Hindu cremation), etc)
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IV. 3. AVERAGE MONTHLY HOUSEHOLD EXPENSES ( IN RUPIAH)Serialno.
Type of expenses During a week Average in amonth*)
During 12months
(1) (2) (3) (4) (5)01 Cereals (IV.1 A)02 Tuber (IV. 1 B)
03 Fish (IV. 1 C)04 Meat (IV. 1 D)05 Egg and Milk (IV. 1 E)
06 Vegetables (IV. 1 F)07 Pulses (IV. 1 G)
08 Fruits (IV. 1 H)09 Oil and Fat (IV. 1 I)10 Beverages materials (IV. 1 J)
11 Spices (IV. 1 K)12 Other consumption’s (IV. 1 L)13 Prepared foods and beverages (IV. 1 M)14 Alcoholic drinks (IV. 1 N)15 Tobacco and betel (IV. 1 O)
16 Sub Total (1 to 15)
17 Sub total (16) x 30 7
18 Housing and Housing facility (IV. 2 A)
19 Goods and Services (IV. 2 B)20 Clothes, Footwear, and Headgear (IV. 2 C)21 Durable goods (IV. 2 D)
22 Tax and Insurance (IV. 2 E)23 Festivities and ceremonies (IV. 2 F)
24 Average of monthly household expenses(17 to 23)*) content of serial number 18 to 23 in Column 4 same as the content of serial number 18 to 23 in Column 5 divided 12
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V. INCOME, REVENUE AND EXPENSES OF NON-FOOD GOODS DURING THE PAST 12 MONTHS(IN RUPIAH)
1. Wages/salary paid in money and in kind2. Income from agriculture business
a. Agriculture of food and non-food crops
b. Other agricultural activities (husbandry, poultry, miscellaneous livestock, fishery, forestry)3. Income from non agricultural business4. Income outside of wage/salary and business
a. Estimated house rent
b. Other (interest, land rental, rentals and leases, pension, duty-binding scholarship, claimed life insurance, dividend,loss and accident claims, income from non-business activities, )
5. Expenses and revenue from transfers
Expenses: Revenue: (money sent, donation, gifts, bequests, and aid) (received money transfer, inheritance, donation, gift, aid)
6. Other expenses and revenue
Expenses: Revenue:a. Purchased of bond/gold/jewelry, immovable goods a. Sold of bond/gold/jewelry/immovable goods, second-
including building renovation hand goods
b. Others (saving, paid of insurance, loan/paid back loan, b. Others (took the saving, claimed other insurance,down payment, “arisan” dues= regular social gathering received “arisan” , made loan, pawned goodswhose member contribute to and take turns receiving thesum of money etc)
7. Household Income/revenue(Amount of income/revenue, details 1 to 6 – total expenses, details 5 to 6)
8. Average monthly household income/revenue (details 7 : 12)
53
54
VI. NOTES
