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PROFILE
Full Name:
Date of Birth:
Gender:
Male
Female
Marital Status:
Single
Married
Separated
Email Address:
State:
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
City:
Mobile #:
+ 91
STD Code #:
Landline #:
INTERNET
On an average, how many hours in total, do you access the Internet on a typical weekday and weekend?
On a typical weekday (an average day like Mon/ Tue / Wed / Thu / Fri)?
00 Hour
01 Hour
02 Hours
03 Hours
04 Hours
05 Hours
06 Hours
07 Hours
08 Hours
09 Hours
10 Hours
11 Hours
12 Hours
13 Hours
14 Hours
15 Hours
16 Hours
17 Hours
18 Hours
19 Hours
19 Hours
21 Hours
22 Hours
23 Hours
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01 Minute
02 Minutes
03 Minutes
04 Minutes
05 Minutes
06 Minutes
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09 Minutes
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58 Minutes
59 Minutes
On a typical weekend / holiday (an average Saturday or Sunday)?
00 Hour
01 Hour
02 Hours
03 Hours
04 Hours
05 Hours
06 Hours
07 Hours
08 Hours
09 Hours
10 Hours
11 Hours
12 Hours
13 Hours
14 Hours
15 Hours
16 Hours
17 Hours
18 Hours
19 Hours
19 Hours
21 Hours
22 Hours
23 Hours
00 Minute
01 Minute
02 Minutes
03 Minutes
04 Minutes
05 Minutes
06 Minutes
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09 Minutes
10 Minutes
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58 Minutes
59 Minutes
Where all do you access internet from?
Home
Office
Cyber Cafe
School/College
Friends/Relatives
Mobile
On which devices do you access the Internet?
Desktop, Laptop/Notebook
Mobile Phone/Smart Phone
Tablets
Among these, which device do you use to access the Internet the most?
Desktop, Laptop/Notebook
Mobile Phone / Smart Phone
Tablets
DEVICES
Which of these items do you have at home?
Electricity connection
Ceiling fan
LPG Stove
Two Wheeler
Colour TV
Refrigerator
Washing Machine
Personal Computer/Laptop
Car/Jeep/Van
Air conditioner
Agricultural land
Which device are you using currently?
Desktop, Laptop/Notebook
Tablet
Mobile
How many more people access the device that you are using currently?
The device is used only by me
2 people
3 people
4 or more people
How do you receive TV programmes on your TV sets?
Cable Operator
Ordinary TV Antenna
Direct to Home (DTH) e.g. Tata Sky, Dish TV etc.)
Conditional Access System (CAS) β a set top box provided by the cable operator to receive pay channels.
Other mean (specify)
Please specify if other
FAMILY
Number of members in the your household
01
02
03
04
05
06
07 or more
Are you the chief wage earner in your family?
Yes
No
Occupation of the family chief wage earner
Unskilled Worker
Skilled Worker
Petty Trader
Shop Owner
Businessman or Industrialist with no employees other than self
Businessman or Industrialist with 1-10 employees
Businessman or Industrialist with more than 10 employees
Self-employed professionals
Clerk/Salesman
Supervisor level employee
Junior level Officer/Executive
Middle or senior level Officer/Executive
Education of the family chief wage earner
School up to 4 years
School up to 5-9 years
SSC / HSC
Some college but not graduate
Graduate / Post Graduate (General)
Graduate / Post Graduate (Professional)
Illiterate
VERIFY
I, as a registered member, do hereby expressly agree to the conditions laid out in the
Terms of use
and
Privacy policy
. I also authorize IMRB to call/SMS me on my registered phone numbers. I expressly state that such authorization shall override the national Do-Not-Disturb Registry (βDNDβ) for IMRB hereafter.
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