QUESTIONNAIRE 1.

Name:
2. Sex: 3. Age:

Male Below 25

Female 25 to 35 Married 35 to 50 Unmarried Above 50

4. Marital Status:

5. Educational Qualification: Illiterate Higher secondary 6. Employment status: Employed Retired Salary Pension Wages Agriculture 5000-15000 Above35000 10-25 cent 75- 1 acre No 25-50 cent above 1 acre 15000-25000 Unemployed Homemaker Business Matriculation Graduate

7. State the main source of income:

8. Average monthly income: Less than 5000 25000-35000 Up to 10 cent 50-75 cent Yes a. Commercial bank b. Cooperative bank c. NBFI

9. Nature and area of land owned:

10. Do you borrow money from any source: If yes, specify the source:

d. Informal source (money lender, friends and relatives) 11. Purpose of borrowing loan: Agricultural loan Trade loan 12. Period of loan: Short term loan (up to 1 year) Medium term loan (up to 5 years) Long-term loan (more than 5 years) 13. Specify the security you have given for taking loan: Land Gold House property Salary Certificate 14. Details of loan availed during last 5 years including the current loan: No. Type Loan of loan 1 2 3 4 5 Lende Period Repayment status Repayment Interest No Amount Period of schedule rate default of of loan default default Business loan (Non farm loan) Personal loan (Housing, Educational loan,)

amount r

15. Whether you repay your loan promptly: Yes No

16. If no, specify the reason for default/non repayment of loan: No. Factor/Reason 1 2 Low income generation Loss from business/agricultural 3 4 5 activities Diversion of money High interest rate Personal/Domestic reason NA(0 ) Least Important(1) (2) Neutral(3) (4) Most important(5)