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SUSENAS SSN87-S2

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RUPUBLIC OF ONDONESIA CENTRAL BUREAU OF STATISTICS

1987 NATIONAL SOCIO-ECONOMIC SURVEY

CONSUPMTION/HOUSEHOLD EXPENDITURES LISTING CONFIDENTIAL

I. INDENTIFICATION II. HOUSEHOLD LISTING Worked Status 01. Province

02. Regency/Municipality *)

Serial Number

Source of Income Workers/ employee

Have a business

03. District (1) (2) (3) (4) 04. Village 01. Agriculture, Husbandry, Forestry, Hunting, and

Fishery 1 2

05. Area Urban -1 Rural -2 02. Mining and Quarrying 06. Enumerating Area Number 03. Manufacture industry

04. Electricity, water and gas 07. Census Block Number 05. Building/construction 06. Large trade, Retail, Restaurant, and Hotel 08. SUSENAS Sample Code Number 07. Transportation, Stored, and Communication

09. Sample Household serial number 08. Finance, Insurance, buildings rental business, Land, and Service Establishment

09. Community, social and individual Services 10. Number of Household member 10 Other 11 Income (pension, gifts, etc) 11. Name of Household Head 12. From all income above, the main income is

…………………………………………….

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4

III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

001 A. Cereals 002 Local rice Kg 003 High quality rice Kg 004 Imported rice Kg 005 Sticky rice Kg 006 Wet corn with a skin Kg 007 Dried corn with a skin Kg 008 Dry-shelled corn Kg 009 Rice flour Kg 010 Corn flour (maizena) Kg 011 Wheat flour Kg 012 Other ………………. 013

B. Tuber

014 Cassava Kg 015 Sweet potato Kg 016 Potato Kg 017 Taro Kg 018 Dried cassava chip Kg 019 Cassava flour (Tapioca) Kg 020 Dried Cassava chip flour Kg 021 Sago (not made from cassava,

example: Ambon Sago) Kg

022 Other: ……………….

5

6

III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

023 C. Fish 1) Fresh fish

024 Yellow tail fish Kg 025 Tuna Kg 026 “Cakalang” Kg 027 “Tenggiri” fish Kg 028 “Selar” fish Kg 029 “Kembung” fish Kg 030 “Teri” (small fish) Kg 031 “Bandeng” fish Kg 032 “Gabus” fish Kg 033 Tilapia fish Kg 034 Gold fish Kg 035

Other 2) Fresh shrimp and its types

036 Shrimp Kg 037 Squids Kg 038 Crab Kg 039 Other Kg

3) Preserved fish

040 Salted “Kembung” fish Ons 041 “Tenggiri” fish

Ons

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8

III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK Purchasing

(cash/credit) Own production Dividend,

distribution, etc Total consumption Serial

number Detail Type/

quality Standard

unit Quantity

(0,00) Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

042 “Teri” (small fish) Ons 043 “Selar” fish Ons 044 “Sepat” fish Ons 045 “Bandeng” fish Ons 046 “Gabus” fish Ons 047 Fish in a can Ons 048 Other

4) Preserved Shrimp and its types

Ons

049 Shrimp Ons 050 Squid Ons 051 Other Ons 052

D. Meat 1) Fresh meat

053 Beef Kg 054 Buffalo Kg 055 Horse Kg 056 Lamb Kg 057 Ham Kg 058 Purebred chicken Kg 059 Free-range chicken Kg 060 Other poultry meat Kg 061 Other meat

Kg

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

062

2) Preserved meat Dried meat

Kg

063 Smoke meat Kg 064 Dried shredded meat Kg 065 Meat in a can Kg 066 Other Kg 067

3) Other Liver

Kg

068 Innards (other than liver) Kg 069 Tetelan (bones with a bit of

adhering meat) Kg

070 Bones Kg 071 Other Kg 072

E. Egg and milk

073 Chicken egg Kg 074 Duck egg pieces 075 Quail egg Pieces 076 Other egg Pieces 077 Salted egg Pieces 078 Pure milk Liter 079 Dairy product 250 ml 080 Sweeten condensed milk Kg 081 Can’s powder milk

Kg

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

082 Baby’s powder milk Kg 083 Powder milk (in kilogram) Kg 084 Cheese Ons 085 Other dairy product 086

F. Vegetables

087 Spinach Kg 088 Swamp cabbage Kg 089 Cabbage Kg 090 Mustard white Kg 091 String bean Kg 092 Legume (green bean) Kg 093 Tomato Ons 094 Carrot Kg 095 Cucumber Kg 096 Cassava leaves Kg 097 Egg plant Kg 098 Bean sprouts Kg 099 Siam Gourd Kg 100 Radish Kg 101 Vegetable soup Packet 102 “asam” soup (‘sour’ soup) Packet 103 Young Jack fruit Kg 104 Young papaya

Kg

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

105 Mushrooms Ons 106 Petai Kg 107 Jengkol Kg 108 Shallots Ons 109 Garlic Ons 110 Red peppers Ons 111 Green peppers Ons 112 Cabe rawit Ons 113 Canned vegetables Kg 114 Other Vegegables 115 G. Beans & Nuts (Sub-total) 116 Ground nuts Kg 117 Soy beans Kg 118 Green beans Kg 119 Red beans Kg 120 Polong nuts Kg 121 Tunggak nuts Kg 122 Cashews Ons 123 Other beans/nuts Kg 124 Tofu Kg 125 Tempe Kg 126 Tauco Kg 127 Oncom

Kg

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

128 Saridele” Kg 129 Other 130

H. Fruits

131 Orange Kg 132 Mango Kg 133 Apple Kg 134 Avocado Kg 135 “Rambutan” Kg 136 Lanzon Kg 137 Durian Kg 138 Snake fruit Kg 139 Pineapple Kg 140 Banana Kg 141 King “Raja” banana Kg 142 Other banana Kg 143 Papaya Kg 144 Rose-apple Kg 145 Sapodilla Kg 146 Star fruit Kg 147 “Kedondong” Kg 148 Watermelon Kg 149 Jack fruit Kg 150 Tomato

Kg

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK Purchasing

(cash/credit) Own production Dividend,

distribution, etc Total consumption Serial

number Detail Type/

quality Standard

unit Quantity

(0,00) Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

151 Canned fruit Kg 152 Other 153 I. Oil and fat 154 Coconut oil Liter 155 Corn oil Liter 156 Other cooking oil Liter 157 Coconut Pieces 158 Margarine Ons 159 Other 160 J. Beverages materials 161 Granulated sugar Ons 162 Tea Ons 163 Powder coffee Ons 164 Coffee bean Ons 165 Powder chocolate Ons 166 Syrup 620ml 167 Other 168 K. Spices 169 Salt Ons 170 Macadamia nut

Ons

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

171 Coriander Ons 172 Pepper Ons 173 Tamarind Ons 174 Nutmeg Ons 175 Clove Ons 176 Fish paste Ons 177 Soy sauce 10 ml 178 Palm sugar Ons 179 Monosodium glutamate Ons 180 Other cooking spices 181 L. Other consumption 182 Crackers Ons 183 Crisp chip Ons 184 Noodle Kg 185 Wheat & rice noodle Kg 186 Macaroni Kg 187 Other 188 M. Prepared foods and drinks 189 Bread Ons 190 Other bread 191 Dry cake

Ons

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK

Purchasing (cash/credit)

Own production Dividend, distribution, etc

Total consumption Serial number

Detail Type/ quality

Standard unit

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

192 Wet cake 193 Mungbean porridge 194 “Gado-gado” (vegetables mixed

with peanut butter)

195 Plate of rice and side dish 196 Meat ball & noodle 197 Syrup ice 198 “Mambo” ice 199 Other ice CO2 Soft drink 200 In a bottle 250 ml 201 In a can 330 ml Non CO2 Soft drink 202 In a bottle 200 ml 203 In a can 330 ml 204 Other packaging 200 ml 205 Other beverages 206 Other

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III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK Purchasing

(cash/credit) Own production Dividend,

distribution, etc Total consumption Serial

number Detail Type/

quality Standard

unit Quantity

(0,00) Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (0,00)

Value(Rp)

Quantity (5)+(7)+(9)

(0,00)

Value (6)+(8)+(10)

(Rp) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

207 N. Alcohol beverages 208 Bier 620 ml 209 Wine 620 ml 210 Other alcohol drinks 211 O. Tobacco and betel 212 Filtered cove cigarette 10 pieces 213 Unfiltered clove cigarette 10 pieces 214 Menthol cigarette 20 pieces 215 Cigar pieces 216 Tobacco Ons 217 Betel/areca nut 218 Other

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 219 220

A. Housing, Fuel, Electricity, and Water This house is: Own property/free of rent -1 Rent purchased -4 Lease -2 Official house -5 Rents -3 Other -6

221 If own property, estimation monthly renting: Rp. …………………. 222

If the house is lease: a. Lease agreement : Rp. ……………. b. Value of lease : Rp. ……………. c. Average value of lease in a month: Rp. …………….

223 If this house rented, value of monthly renting: Rp. ……………. 224 If the status of dwelling is rent purchased, official, and other,

average value of monthly renting: Rp. …………….

225 Maintenance costs (plastering/painting the wall, painting, replace the leakage roof, broken glasses, hinge, etc

226 227

Electricity: Quantity: a. 12 months ago: ……………….. kwh/watt *) Fill in by b. a month ago: ……………….. kwh/watt *) CBS Value:

228 229

Natural Gas: Quantity: a. 12 months ago: ……………….. m3 b. a month ago: ……………….. m3 Value:

230 231

LPG: Quantity: a. 12 months ago: ……………….. kg b. a month ago: ……………….. kg Value:

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 232 233

Kerosene: Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

234 235

Generator: a. Gasoline Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

236 237

a. Solar fuel Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

238 239

c. Kerosene Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

240 241

d. Lubricant oil Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

242 e. Maintenance and repair 243 244

Charcoal: Quantity: a. 12 months ago: ……………….. kg b. a month ago: ……………….. kg Value:

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 245 Firewood 246 Water 247 Other (Flashlight, storage battery, matches, mosquito repellent, etc) 248 249

b. Goods and Services Bathing soap, toothpaste, and shampoo

250 Beauty’s stuffs (perfume, pomade, deodorant, powder, etc) 251 Treatments of skin, face, nails, hair (cutting, curl, etc)

Health

252 a. Doctor’s cost 253 b. Treatment’s cost 254 c. Midwife’s cost 255 d. Paramedic’s cost 256 e. Contraceptive’s cost 257 f. Traditional healer’s cost 258 g. Medicine with doctor’s prescription 259 h. Medicine without doctor’s prescription 260 i. Other

Cost of school/course

261 a.School Development Contribution (Enrollment fee) 262 b. School fee and contribution for BP3/POMG 263 c. Other school contribution 264 d. Text book 265 e. Stationary (including photo copy) 266 f. Course’s fee

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 267 Newspaper, magazine, books, and stationers (exclude school and course needs)

including rents of magazine/literatures

268 Post, telegram, telephone, and post materials 269 270

Motor Vehicle a. Gasoline: Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

271 272

b. Solar fuel Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

273 274

c. Lubricant oil Quantity: a. 12 months ago: ……………….. liter b. a month ago: ……………….. liter Value:

275 d. Maintenance and repair of vehicle 276 Transportation cost (bus, train, airplane, ship, “becak”, parking fee, etc) 277 Cinema, play, sport, and other recreation, (exclude transportation and goods for

recreation)

278 Housemaid and driver (salary or wage only) 279 Other (toothbrush, camphor, photo copy, etc) 280 281

B. Clothes, Footwear, and head gear Ready made man’s wear (Blazer, long-sleeved shirt, Jacket, sarong, pants, T-shirt,

underwear, etc

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 282 Ready made woman’s wear (Gown, long fabric, blouse, nightgown, sweater, skirt,

sarong, shawl, “angkin” (cloth waisband), underwear, etc)

283 Ready made children’s wear (clothes, pants, sweater, T-shirts, under wear, etc) 284 Fabrics for men’s clothes (wool, polyester, cotton, silk, etc) 285 Fabric for woman’s clothes 286 Fabric for children’s clothes 287 Sewing cost and fixed the clothes 288 Footwear for man (shoes, sandal, sock, etc) 289 Footwear for woman 290 Footwear for children 291 Head gear for man, woman and children (hat, ‘kopiah” =rimless cap, veil, etc) 292 Thread, and other stuffs of sewing needs 293 Laundry-soap (in bar form) 294 Powder soap and cream soap 295 Others (towel, belt, shoe polish, tie, tailor-fee, etc) 296 297

D. Durable goods Household furniture (table, chair, bed, wardrobe, sewing machine, refrigerator, fan)

298 Supporting of household furniture (mattress, pillow, table cloth, bed sheet, pillow sheet, blanket, curtain, rug, etc.)

299 Instruments of household (iron, broom, scissors, electric tools, knife, machete, saw, etc)

300 Cooking & eaten utensils (rack of plate, stove, cooking pot, pan, pail, wok, spoon, thermos bottle, plate, glass, and other utensils made of glass, ceramic, and plastic, etc)

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III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO

Value in Rupiah Serial number

Detail 12 months ago Month ago

(1) (2) (3) (4) 301 Repairs of furniture, supporting and instrument of household 302 Watch, clock, camera, glasses and its repairs 303 Umbrella, bag, luggage, and its repairs 304 Expensive jewelers (gold, diamond, pearls, etc) and its repairs 305 Children’s toy, cheap jewelry and its repairs 306 Entertainment instruments (T.V, video, radio cassette, guitar, piano, etc) and its repairs 307 Sports equipment (chess, racket, ball, net, etc) and its repairs 308 Vehicle (bicycle, motor cycle, car) and its repairs 309 Other durable goods (wall hanging decoration, aquarium, electric installation,

telephone, pipe and its repairs)

310 311

E. Tax and Insurance

Building and Land tax (PBB)

312 Radio and TV tax, and it’s type 313 Tax of motor and non-motor vehicle 314 Other levied (contribution, etc) 315 Health and accident insurance 316 317

F. Festivities and ceremonies

Marriage

318 Circumcision, birthday 319 Celebrating of religious ritual (“Idul Fitri”, :Idul Adha”, Christmas,/New Year,

“Waisak”, “Galungan”, etc)

320 Other traditional ceremonies (“selamatan”, offering, etc) 321 Funeral

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III. 3. SUMMARY OF HOUSEHOLD EXPENDITURE

Serial number

Type of expenditure During a week (Rp)

During 12 months (Rp)

During a month (Rp)

(1) (2) (3) (4) (5) 01 Cereals (III.1 A) 02 Tuber (III.1 B) 03 Fish (III.1 C) 04 Meat (III.1 D) 05 Egg and milk (III.1 E) 06 Vegetables (III.1 F) 07 Pulses (III.1 G) 08 Fruits (III.1 H) 09 Oil & Fat (III.1 I) 10 Beverages material (III.1 J) 11 Spices (III.1 K) 12 Other consumption (III.1 L) 13 Prepared food and drink (III.1 M) 14 Alcohol drink (III.1 N) 15 Tobacco and betel leaves (III.1 O) 16 Sub total (1 to 15) 17 Sub total (16) x 30

7

18 Expenses for housing, fuel, electricity, and water (III.2 A) 19 Expenses for goods and services (III.2 B) 20 Expenses for clothes, footwear, and head gear (III.2 C) 21 Expenses for durable goods (III.2 D) 22 Tax and insurance (III.2 E) 23 Expenses for festivities and ceremonies (III.2 F) 24 Total expenses (17 to 23)

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IV. MONTHLY HOUSEHOLD INCOME/REVENUE A. Income of salary/wage in form of money or in-kind/services which received during previous month (Rp)

Salary/Wage Serial number

Name of Household member Main work Additional work

Overtime, honorarium, etc

In-kind of salary/wage

Total column (3) to (6)

(1) (2) (3) (4) (5) (6) (7)

B. Income from agriculture business during previous year (Rp)

Type of business Production

To sell

Own consumption

Given to other party

Production left over

Total Col. (3) to (6)

Production cost

Income Col. (7) – (8)

Average of monthly

income col. (9) : 12

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 1. Agriculture (1a + 1b)

a. Food plants 1) Cereals 2) Tuber 3) Pulses 4) Vegetables

5) Fruits

b. Non-food plants Plantation

Other than plantation 2. Husbandry (2a + 2b)

a. Livestock

b. Other (milk, fertilizer)

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42

IV. MONTHLY HOUSEHOLD INCOME/REVENUE

B. Continued

Type of business Production

To sell

Own consumption

Given to other party

Production left over

Total Col. (3) to (6)

Production cost

Income Col. (7) – (8)

Average of monthly

income col. (9) : 12

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 3. Poultry husbandry (3a + 3b)

a. Fowl b. Other (egg, hair, etc)

4. Variety of livestock (rabbit, quail, etc)

5. Fishery 6. Forestry/Hunting

Total (B1 to B6) C. Income of non agriculture business during 3 months ago (Rp)

Type of business Number of business month

Production

To sell

Own consumption

Given to other party

Production left over

Total Col. (4) to (6)

Production cost

Income Col. (7) – (8)

Average of monthly

income col. (10) : 12

(1) (2) (4) (5) (6) (7) (8) (9) (10) (11) 1. Industry/handicraft 2. Trade 3. Transportation

4. Other (construction, quarrying, etc)

Total (C1 to C5)

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44

IV. MONTHLY HOUSEHOLD INCOME/REVENUE

D. Other income (besides salary/wage and business) during previous month Type of income Rp

1. Interest 2. Land leased 3. Lease/contract (building, party equipment’s, etc) 4. Dividend 5. pension 6. Income from ‘gift’ (official boundary, scholarship, etc) 7. Other income from:

a. Agriculture sector which not a business field b. Other sector which not a business field 8. Claimed of Life insurance 9. Estimation of monthly house renting 10. Other

Total (D1 to D10) E. Payment and revenue of transfer during previous month

Revenue Rp Expenses Rp (1) (2) (3) (4)

1. Receive money transferred 1. Sending money 2. Will 2. Give donation, gift, grant, aid 3. Receive donation, gift, grant, and aid

Total

Total

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IV. MONTHLY HOUSEHOLD INCOME/REVENUE F. Other Income and expenses during previous month Income Rp Expenses Rp (1) (2) (3) (4) 1. Selling of bonds/gold/jewelry 1. Purchase bonds 2. Selling of immovable goods (building, land) 3. Selling of second hand goods

2. Purchase immovable goods includes large repaired building/pamatangan tanah

4. Saving withdrawal 3. To pay insurance premium 5. Other insurance claimed 4. Saving 6. Lend/received credit 5. To lend/paid credit 7. Pawn the goods 6. Execution pawn goods 8. Receive ‘arisan’ 7. Pay ‘arisan’ 9. Other 8. Other Total Total G. Household expenses and revenue during previous month

Expenses Rp Revenue Rp (1) (2) (3) (4)

1. Income of salary/wage Total column (7) block IV. A

1. Expenses of household consumption block III.3 detail 24 column (5)

2. Income of agriculture business Total column (10) block IV. B

3. Income from non agriculture business Total column (11) block IV. C

2. Transfer payment Total column (4) block IV. E

4. Other income Total column (2) block IV D

5. Receive transfer Total column (2) block IV E

3. Other expenses total column (4) block IV F

6. Other revenue Total column (2) block IV F

Total Total

Note: Number purchase of second hand goods: a. During previous month = Rp. ………. b. During previous year = Rp ………….