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1. Name

2. Gender

3. Age

4. Where were you born?

5. Where do you live?

6. What is the name of the place where you live?

7. Is the place you live a city, a town or a village

8. Highest educational level completed

9. What is your occupation?

10. Are you self-employed?

11. What is the name of the organization you work for?

12. What is your job title?