To the Head (or Acting Head) of the Household. Please complete this form and have it ready for collection on Monday 26th April. If you need help, do not hesitate to ask the enumerator. The enumerator may ask you any questions necessary to help him to complete or correct the form. The information you give on the form will be treated as CONFIDENTIAL and used only for compiling statistics. No information about named individuals will be passed by the Census Office to any other Government Department or any other authority or person. If anyone in the census organization improperly discloses information you provide, he will be liable to prosecution. Similarly you must not disclose information which anyone (for example, a visitor or boarder) gives you to enable you to complete the form. The legal obligation to fill in the whole form rests on YOU, but each person who has to be included is required to give you the information you need. However, anyone who wishes can ask the enumerator or local Census Officer for a personal from which can be returned direct to the enumerator or local Census Officer and then you need only questions B1 and B5 for that person. PLEASE TAKE NOTE There are penalties of up to £50 for failing to comply with the requirements described above, or for giving false information. When you have completed the form, please sign the declaration at the foot of the last page. Office of Population Censuses and Surveys, Titchfield, Fareham, Hants. MICHAEL REED Director and Registrar General

A household comprises either one person living alone or a group of persons (who may or may not be related) living at the same address with common housekeeping. Persons staying temporarily with the household are included. To be completed by enumerator C.D No. E.D.No. Form No. Ref. . . . . . . . . . If sharing with another household:- Hall, staircase, passage, etc., shared only/not only* for entry to accommodation. *delete whichever is inapplicable. Number of rooms shared. ..... Name and full postal address: ....................................................................................................... ........................................................................................................ ........................................................................................................ ........................................................................................................

Part A

PART A Answer questions A1-A5 about your household's accommodation and then answer questions B1-B24 overleaf and if appropriate answer questions C1-C7. Where boxes are provided answer by putting a tick in the box against the answer which applies. For example, if the answer is 'YES': PLEASE WRITE IN INK OR BALLPOINT PEN A1 How do you and your household occupy your accommodation? 1 As an owner occupier (including purchase by mortgage) 2 By renting it from a Council or New Town 3 As an unfurnished letting from a private landlord or company or Housing Association 4 As a furnished letting 5 In some other way (Please give details, including whether furnished or unfurnished) .................................................................................................................................... Note: If the accommodation is occupied by lease originally granted for, or since extended to, more than 21 years, tick 'owner occupier'. A2 Does your household share with anyone else the use of any room, or hall, passage, landing, or staircase?   YES NO A3 How many rooms are there in your household? ................... Do not count Small kitchens less than 6ft. wide Bathrooms and toilets, ...not used for cooking closets, pantries and storerooms, landings, halls, lobbies or recesses, offices or shops used solely for business purposes. Note: A large room divided by a sliding or fixed partition should be counted as two rooms. A room divided by curtains or portable screens should be counted as one room. A4 How many cars and vans are normally available for use by you or members of your household (other than visitors)? ............................ Include any provided by employers if normally available for use by you or members of your household, but exclude vans used solely for the carriage of goods. If None, write 'NONE'. A5 Has your household the use of the following amenities on these premises? a A cooker or cooking stove with an oven   1 YES- for use only by this household   2 YES- for use also by another household   3 NO b A kitchen sink permanently connected to a water supply and a waste pipe 1 YES- for use only by this household 2 YES- for use also by another household 3 NO c A fixed bath or shower permanently connected to a water supply and a waste pipe 1 YES- for use only by this household 2 YES- for use also by another household 3 NO d A hot water supply (to a washbasin, or kitchen sink, or bath, or shower) from a heating appliance or boiler which is connected to a piped water supply 1 YES- for use only by this household 2 YES- for use also by another household 3 NO e A flush toilet (W.C.) with entrance inside the building 1 YES- for use only by this household 2 YES- for use also by another household 3 NO f A flush toilet (W.C.) with entrance outside the building 1 YES- for use only by this household 2 YES- for use also by another household 3 NO     PART B Complete a line in Part B for every person present, that is every person who a) spends Census night 25/26 April 1971 in this household or b) joins this household on Monday 26 April and has not been included as present on a Census form elsewhere. For any other person who usually lives in this household complete a line in Part C on the back page. *Up to six persons could fill in their details on the Census form in separate columns, this document only shows one column to save space and to avoid replication. B1 Fill in this column first for every person present. (see note above) Write name and surname. Begin with the head of the household (if present). For a baby who has not yet been given a name write 'BABY' and the surname. 1st person B2 Write the date of birth of the person   Day   Month Year     B3 Write the sex of the person, (M for male, F for female)       B4 If the person usually lives here, write 'HERE'. If not, write the person's usual address. For boarders write 'HERE' only if they consider this their usual address. For students and children who are away from home during term time give their home address. For persons with no settled address write 'NONE'. BLOCK CAPITALS PLEASE     B5 Write 'HEAD' for the head of the household and relationship to the head for each of the other persons; for example 'Wife', 'Son', 'Daughter-in-law', 'Visitor', 'Boarder', 'Paying Guest'.     B6 Write 'SINGLE', 'MARRIED', 'WIDOWED' or 'DIVORCED' as appropriate. If separated and not divorced write 'MARRIED'.     B7 Did the person have a job last week (the week ended 24th April 1971)?(see note B7) Tick box 1 if the person had a job even if it is only part-time or if the person was temporarily away from work, on holiday, sick, on strike, or laid off. If the person did not have a job tick whichever of boxes 2,3,4 or 5 is appropriate; if box 5 is ticked state the reason; for example 'Housewife', 'Student', 'Permanently sick'. This question need not be answered for children under 15 years of age.   1 YES- in a job at some time during the week 2 NO- seeking work or waiting to take up job 3 NO- intending to seek work but sick 4 NO- wholly retired 5 NO- not seeking work for some other reason, namely .................................................... B8 Will the person be a student attending full-time at an educational establishment during the term starting April/May 1971? (see note B8) This question need not be answered for children under 15 years of age YES NO B9 a If the person was born in England or Wales or Scotland or Northern Ireland tick the appropriate box. or b If the person was born in another country, write the name of the country (using the name by which it is known today) and the year in which the person first entered the United Kingdom (that is England, Wales, Scotland and Northern Ireland). a Born in   England 01 Scotland 02 Wales (incl. Monmouthshire) 03 Northern Ireland or b Born in .........................(country) and entered U.K. in .................(year) B10 Write the country of birth of: a the person's father b the person's mother This question should be answered even if the person's father or mother is no longer alive. (If country not known, write 'NOT KNOWN') Give the name by which the country is known today.   a Father born in (country)   b Mother born in (country) B11 Was the person's usual address one year ago (on 25th April 1970) the same as that shown by the answer to question B4? Write 'YES' or 'NO'. If no, write also the usual address on 25th April 1970. For a child now under one year of age, write 'UNDER ONE'. BLOCK CAPITALS PLEASE     B12 Was the person's usual address five years ago (on 25th April 1966) the same as that shown by the answer to question B11?   Write 'YES' or 'NO'. If no, write also the usual address on 25th April 1966. For a child now under five years of age, write 'UNDER FIVE'. BLOCK CAPITALS PLEASE     B13 Has the person obtained any of the following?   G.C.E. 'A' level Higher School Certificate (HSC) Higher grade of Scottish Certificate of Education (SCE) Higher grade of Scottish Leaving Certificate (SLC) Ordinary National Certificate (ONC) Ordinary National Diploma (OND) This question need not be answered for children under 15 or retired persons over 70.   1 GCE 'A' level or HSC 2 SCE higher or SLC higher 3 ONC or OND 4 None of these B14 Has the person obtained any of the following qualifications since reaching the age of 18? a H.N.C or H.N.D b Nursing qualifications c Teaching qualifications d Degrees, diplomas or other educational qualifications e Graduate or corporate membership of professional institutions f Any other professional or vocational qualifications If so, give full details of all such qualifications in the order in which they were obtained, even if not relevant to the present job or if the person is not working. If none, write 'NONE'. Please check these details by asking each person about his qualifications This question need not be answered for persons under 18 or retired persons over 70. Qualification Major Subject(s) Awarding Institution Answer questions B15-B17 in respect of the main employment last week, or of the most recent job if retired or out of work. For persons who have never had a job and for a housewife who did not have a job last week write 'NONE' at B15 B15 What was the name and business of the person's employer (if self-employed, the name and nature of the person's business)? (see note B15) Give the trading name if one was used. a Name of business   b Nature of business B16 a What was the person's occupation? Give full details. (see note B16) b Describe the actual work done in that occupation.   a Occupation   b Description of work B17 Was the person   an employee,   or self-employed employing others (see note B17),   or self-employed without employees?   1 An employee 2 Self-employed employing others (see note B17) 3 Self-employed without employees For all persons with a job last week. For persons with more than one job these questions apply to the main employment last week. B18 If the person is an apprentice or trainee, write 'Apprentice', 'Articled clerk', 'Articled pupil', 'Student apprentice', 'Graduate apprentice', 'Management trainee', 'Trainee technician', or 'Trainee craftsman' as appropriate. (see note B18)     B19 How many hours per week does the person usually work in this job? Exclude overtime and meal breaks.     B20 What is the full address of the person's place of work? (see note B20) If the work is carried out mainly at home write 'AT HOME'. BLOCK CAPITALS PLEASE     B21 What means of transport does the person normally use for the longest part, by distance, of the daily journey to work? (see note B21) If the person walks to work, or works mainly at home, write 'NONE'.                       B22 What means of transport does the person normally use for the longest part, by distance, of the daily journey to work? (see note B21) If the person walks to work, or works mainly at home, write 'NONE'. For women aged under 60 who are married, widowed or divorced.   B23 Enter the month and year of birth of each child alive to her in marriage; include any who have since died. If none, write 'SAME'. Enter the dates in order of birth, starting with the first born. If she has been married more than once give the dates for the children of all her marriages. Month Year Month Year B24         a Write the month and year of marriage (the first marriage if married more than once). b If the first marriage has ended (by the husband's death or by divorce) write the month and year when it ended. If not ended, write 'NOT ENDED'.   a Date of (first) marriage   Month Year a Date (first) marriage ended   Month Year