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Questionnaire to Evaluate the Financial Need of Men/Women

Code of Respondent:________ Source Of Credit:
(1) ________________ (2) ________________ (3) ________________

SECTION 1 Information about Respondent and Family 1 Name of the respondent 2 Gender (i) Male (ii) Female 3 Age 4 Marital Status 5 Qualification 6 Position in Family (i) Head (ii) Member 7 If married, No of children (i) Male Adult_______ (ii) Female Adult________ (iii) Children below 10______ 8 School Going Children (i) Male____________ (ii) Female___________ (iii) Total____________ 9 Address 10 Rural/Urban/Semi Urban SECTION 2
Information about Credit and Business

1 2 3 4 5 6 7 8 9 10 11

Nature of business Month and year of starting the business/Earning activity? Source of initial investment. Your earlier business Experience? Month and year of borrowing? Purpose of borrowing? Amount of credit? Is the amount of credit sufficient? Time period of loan? Rate of interest when borrowed? Is the rate of interest reasonable?

(i) Yes (ii) No (i) ___________________ (ii) ___________________ (iii) ________________ ___

12 If yes, would you like to borrow at higher rate of interest? 13 Where was loan utilized?
(eg. Purchase of raw material, purchase of machinery, paid rent of land, purchase of livestock etc)

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14 Was loan repaid in time? 15 If repayment was delayed, what was the cause of delay? 16 Source of repayment. 17 18 Reason for re-borrowing. 19 If you have already re-borrowed, no of times reborrowed? 20 Total persons employed in the business before utilizing credit? 21 Total persons employed in the business after utilizing credit. 22 Has credit improved your business/Earning 23 If yes, how long did it take to improve your business/Earning? 24 If yes, how much business income has increased due to credit? 25 Was increase in income temporary or permanent? 26 If income has not increased, what are the reasons?
Do you intend to re-borrow after repaying the existing loan?

(i) Income from business

(ii) Other_________

(i) Yes (ii) No

(i) ___________________ _____ (ii) ___________________ _____ (iii) ________________ ________ (iv)___________________ _____ (i) Yes (ii) No (i) ___________________ ______ (ii) ___________________ ______ (iii) ________________ _________ (iv)___________________ ______

27 Will you suggest other people to borrow from Microfinance Institutions? 28 If no, give reasons

SECTION 3 Information about Income and saving 1 Position of respondent in home

(i) Husband (ii) Wife (iii) Other___________

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Main source of income

(i) Agriculture__________ (ii) Business____________ (iii) Other_______________ Before credit After credit

3 4 5

Income from business Income from all other sources Total

SECTION 4 INFORMATION ABOUT CONSUMPTION

(1) Monthly Expenditure On Food

Before Credit Items Meat Vegetables, pulses etc Ghee Wheat/Atta Rice Milk Fruit Sugar, Tea Washing, Bath Soap etc Transport, Marriages etc Other Total Total Annual
Qty Price Value

After Credit
Qty Price Value

(2) Annual Expenditure on clothing

Before Credit Item Childrens dress Ladies Dresses Mens Dresses Other
Qty Price Value

After Credit
Qty Price Value

Utility/Service Electricity Gas Water Telephone Other Total

Total (3) Annual expenditure on utilities/Services Before Credit After Credit

(4) (4) Monthly Expenditures on education and Health care

Description
i ii iii

Before Credit

After Credit

Monthly Fee Average Monthly expenditure on uniform, Books etc Monthly expenditure on family health care Total Monthly Total Annual
(5) Other Annual Expenditures

Description
i ii iii iv

Before Credit

After Credit

Annual Expenditure on construction or repair of dwelling Expenditures on purchase of furniture Expenditures on durables purchased Other expenditures on fixed assets Total Annual
Total Expenditures 1+2+3+4+5

Section 5 Views about effects of credit on Consumption And Saving 1 Has Family consumption increased as (i) Yes result of credit? (ii) No 2 If yes, how much? 3 If no, what are the reasons? (i) ______________________________ (ii) ______________________________ (iii) ______________________________ 4 5 If consumption has increased, Was this increase temporary or permanent? (iv)______________________________ (i) Yes_____________ (ii) No______________ Has your saving increased after credit? If yes, how much? SECTION 6 Effect on position of females: 1 Have you become financially independent as a result of credit? 2 Has your respect in family increased? 3 Has your living standard improved? Thank you