1. # of years in Thane 12 3 4 5+ O O O O O Name on electoral role Yes No O O # of years in this slum 12 3 4 5+ O O O O O Ration card Card No dd/mm/yy Yes No O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Orange Yellow O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Voter ID card Yes No O O Mother tongue Marathi Hindi Kannada Other OOOOOOOO Home Kaccha Own house Semi-pukka Rent Pakka Rent amount/month House OOOOOOOO OOOO Vehicle None 2-Wh Bike Other OOOOOOOO Electricity Own meter Borrowed No elec Water Own Public Toilet Disposal Own Soak pit Public Septic Other Sewage Garbage Bin Open Other OOOOOO OOOOOO OOOO OOOOOO OOOOOO Comforts Cable Tele Fan Mixer Fridge TV Newspaper OOOOOO OOOOOOOO First name: Last name: Address:

2. # of years in Thane 12 3 4 5+ O O O O O Name on electoral role Yes No O O # of years in this slum 12 3 4 5+ O O O O O Ration card Card No dd/mm/yy Yes No O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Orange Yellow O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Voter ID card Yes No O O Mother tongue Marathi Hindi Kannada Other OOOOOOOO Home Kaccha Own house Semi-pukka Rent Pakka Rent amount/month House OOOOOOOO OOOO Vehicle None 2-Wh Bike Other OOOOOOOO Electricity Own meter Borrowed No elec Water Own Public Toilet Disposal Own Soak pit Public Septic Other Sewage Garbage Bin Open Other OOOOOO OOOOOO OOOO OOOOOO OOOOOO Comforts Cable Tele Fan Mixer Fridge TV Newspaper OOOOOO OOOOOOOO First name: Last name: Address:

3. # of years in Thane 12 3 4 5+ O O O O O Name on electoral role Yes No O O # of years in this slum 12 3 4 5+ O O O O O Ration card Card No dd/mm/yy Yes No O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Orange Yellow O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Voter ID card Yes No O O Mother tongue Marathi Hindi Kannada Other OOOOOOOO Home Kaccha Own house Semi-pukka Rent Pakka Rent amount/month House OOOOOOOO OOOO Vehicle None 2-Wh Bike Other OOOOOOOO Electricity Own meter Borrowed No elec Water Own Public Toilet Disposal Own Soak pit Public Septic Other Sewage Garbage Bin Open Other OOOOOO OOOOOO OOOO OOOOOO OOOOOO Comforts Cable Tele Fan Mixer Fridge TV Newspaper OOOOOO OOOOOOOO First name: Last name: Address:

4. # of years in Thane 12 3 4 5+ O ● O O O Name on electoral role Yes No O ● # of years in this slum 12 3 4 5+ ● O O O O Ration card Card No dd/mm/yy Yes No O O ● O O O O O O O O O O O O O O O ● O O O O O O O O O O O O O O O O O Orange Yellow O ● O O O O ● O O O O O O O O O O O O O O O ● O O O O O O O O O O O O O ● O O O O O O O O O O O O O O O O O O O O ● ● O O O O O O O O O O O O O O O O O O O O O O O O O O O O Voter ID card Yes No O ● Mother tongue Marathi Hindi Kannada Other O●OOO●OO Home Kaccha Own house Semi-pukka Rent Pakka Rent amount/month House ●OOO●OOO O●O● 1232 Vehicle None 2-Wh Bike Other O●OOO●OO Electricity Own meter Borrowed No elec Water Own Public Toilet Disposal Own Soak pit Public Septic Other Sewage Garbage Bin Open Other OOOOOO OOOOOO OOOO OOOOOO OOOOOO Comforts Cable Tele Fan Mixer Fridge TV Newspaper OOOOOO OOOOOOOO