MedianPanel Survey form

Speak to the male/female respondent

In order to enrol you as our panel member we need a few basic details. I would be grateful if you could spare a few minutes of your time to answer a few questions. Thank you.

Username of Respondent

Name of Respondent

City / Town / Village

State

District

Country

Pin Code

Whatsapp Number

Mobile

Email ID

Where from did you hear about Median Panel

Q1. Gender

Male

Female

Q2B. Are you the Chief Wage Earner (CWE)? By chief wage earner, I mean the person who makes the highest contribution to the running of the household expenses?

Yes

Q3. Could you tell me the occupation of the chief wage earner of the household? By chief wage earner, I mean the person who makes the biggest contribution to the running of the household?

Q4. Could you tell the Education of the person who makes the highest contribution to the running of the household expenses?

Illiterate	Literate but not formal schooling	School Upto 4 Years	School 5-9 Years	SSC/ HSC	Some college (incl. Dip.) but not graduate	Graduate/Post Graduate - General	Graduate/Post Graduate - Professional
1	2	3	4	5	6	7	8

Q5. SEC To be determined from the below table

EDUCATION / OCCUPATION		Illiterate	Literate but not formal schooling	School Upto 4 Years	School 5-9 Years	SSC/ HSC	Some college but not graduate	Graduate/Post Graduate - General	Graduate/Post Graduate - Professional
Unskilled worker		E2	E2	E2	E1	D	D	D	D
Skilled worker		E2	E1	E1	D	C	C	B2	B2
Petty Trader		E2	D	D	D	C	C	B2	B2
Shop Owner		D	D	D	C	B2	B1	A2	A2
Businessman/Industrialist - (No. of Employees)	none	D	C	C	B2	B1	A2	A2	A1
	1-9	C	B2	B2	B2	B1	A2	A1	A1
	10+	B1	B1	B1	A2	A2	A1	A1	A1
Self-employed professional		D	D	D	D	B2	B1	A2	A1
Clerical/Salesmen		D	D	D	D	C	B2	B1	B1
Supervisory Level		D	D	D	C	C	B2	B1	A2
Officer/Executive Junior		C	C	C	C	B2	B1	A2	A2
Officer / Executive Middle / Senior		B1	B1	B1	B1	B1	A2	A1	A1

Q6. Please take a look at this list and tell me which of these items do you have at home in working condition? (It could be owned by you, your family, or provided by the employer or it could be available in the house you live in but it should be for the use of just you or your family).

Q7. Record NCCS in grid below

Education No of durables \	Illiterate	Literate/School Upto 4 yrs	School Upto 5-9 yrs	SSC/HSC	Some College (Including a diploma) but not Graduate.	Grad./ PG - Gen	Grad./ PG - Prof.
	1	2	3	4	5	6	7
None	E3	E2	E2	E2	E2	E1	D2
1	E2	E1	E1	E1	D2	D2	D2
2	E1	E1	D2	D2	D1	D1	D1
3	D2	D2	D1	D1	C2	C2	C2
4	D1	C2	C2	C1	C1	B2	B2
5	C2	C1	C1	B2	B1	B1	B1
6	C1	B2	B2	B1	A3	A3	A3
7	C1	B1	B1	A3	A3	A2	A2
8	B1	A3	A3	A3	A2	A2	A2
9 +	B1	A3	A3	A2	A2	A1	A1

Q8. What is your Marital Status?

Unmarried

Married WITHOUT kids

Married WITH kids

Divorced

Widowed

Q9. What is your family type?

Nuclear Family

Joint Family

Q10. How many family members are there in your household? (Including you) :

Q11. How many Kids below 15 Years are there in your household? :

Q12. What kind of house do you have?

OWN HOUSE

RENTED HOUSE

COMPANY PROVIDED HOUSE / QUARTERS

Q13. What is your (respondent) Education?

Illiterate	Literate but not formal schooling	School Upto 4 Years	School 5-9 Years	SSC/ HSC	Some college (incl. Dip.) but not graduate	Graduate/Post Graduate - General	Graduate/Post Graduate - Professional
1	2	3	4	5	6	7	8

Q14. What is YOUR (respondent) Type of Occupation/Profession?

Q15. Which Languages do you know & are comfortable in?

HINDI

ENGLISH

VERNACULAR

Q15A. If Yes, in Vernacular Which language do you know?

Q16. What is your Monthly household Income? (Monthly household income I mean overall income whoever belongs to your family and stay at your home)

< Rs. 25,000

Rs. 25,001 – 50,000

Rs. 50,001 – 1,00,000

Rs. 1,00,001 – 1,50,000

Rs. 1,50,001 – 2,00,000

Rs. 2,00,001 – 3,00,000

Rs. 3,00,001 – 5,00,000

Rs. 5,00,001 - 10,00,000

Above Rs. 10,00,000

Q17. Do you do Grocery shopping for your household?

Yes

Q18. Which of the following durables do you have at home?

Preview

Daily Consumables

Dairy Products

Bakery

Confectionary

Snacks

Raedy to Eat

Toiletries

Beverages

Q32. Do you order Foods Online?

Yes (1)

No (2)

Q33. Please mention which food ordering app do you use?

Swiggy (1)

Zomato (2)

Uber Eats (3)

Individual Restaurant Apps (4)

Others (5)

Q34. Do you Go out to Eat?

Yes (1)

No (2)

Q35. With whom do you go out to Eat?

Alone (1)

Friends (2)

Family (3)

Colleagues (4)

Others (5)

Q36. How frequently do you Eat Out?

Everyday (1)

Multiple times a week (2)

Once a Week (3)

Once in a fortnight (4)

Once a Month (5)

Less frequently (6)

Q37. How frequently do you go for Holiday?

Once every 3 months (1)

Once every 6 months (2)

Once every 12 months (3)

Once in 2 Years (4)

Once in 3 years or less (5)

None/others (6)

Q38. Do you go to Gym?

Yes (1)

No (2)

Q39. Do you exercise at home?

Yes (1)

No (2)

Q40. Do you do Yoga?

Yes (1)

No (2)

Q41. Do you do Morning Walk?

Yes (1)

No (2)

Q42. Do you do any health supplements?

Yes (1)

No (2)

Q43. Do you use any online payment platform (other than net banking) for various payments? Which are frequent and which are less frequent?

Apps	Very high frequency	Moderate frequency	Less frequently
Google Pay	1	2	3
PayTm	1	2	3
Airtel money	1	2	3
PhonePe	1	2	3
Others	1	2	3

Q44. Do You have a 2 Wheeler (Bike/Moped/Scoter/Scooty) of your Own?

Yes

Q45. Do you have a 4 Wheeler (Car/Jeep/Van) of your Own?

Yes

Q46. Do you use public transportation/app based transportation for Daily commute?

Yes

Q47. What do you use?

Public Transport (Auto/Bus/Taxi etc.) (1)

Shared Public Transport (Auto/Bus/Taxi etc.) (2)

App Based Transport (Cabs/Bikes) (3)

Q48. On a Daily basis how much do you spend on daily commute/transportation (Public transport/App-based transport)?

Upto Rs. 100/-

Rs. 101 - 200/-

Rs. 201 - 300/-

Rs. 301 - 500/-

Above Rs. 500/-

Preview

Q49. How would you like to get your gift/incentive for participating in the Median Surveys? (Please Select One Option)

UPI(GPay/PhonePe/Paytm)

Bank Account

Q49(A).Which UPI ?

GPay

PayTM

PhonePe

Account Holder Name

Mobile No (Related to this UPI)

UPI ID

Account Holder Name

Bank Name

Branch Name

Account Number

IFSC Code

Preview

Speak to the male/female respondent

Q1. Gender

Q2. Age (Yrs) :

Age Group :

Q2B. Are you the Chief Wage Earner (CWE)? By chief wage earner, I mean the person who makes the highest contribution to the running of the household expenses?

Q3. Could you tell me the occupation of the chief wage earner of the household? By chief wage earner, I mean the person who makes the biggest contribution to the running of the household?

Occupation :

Q4. Could you tell the Education of the person who makes the highest contribution to the running of the household expenses?

Q5. SEC To be determined from the below table

Q6. Please take a look at this list and tell me which of these items do you have at home in working condition? (It could be owned by you, your family, or provided by the employer or it could be available in the house you live in but it should be for the use of just you or your family).

Items owned :

Q7. Record NCCS in grid below

Q8. What is your Marital Status?

Q9. What is your family type?

Q10. How many family members are there in your household? (Including you) :

Q11. How many Kids below 15 Years are there in your household? :

Q12. What kind of house do you have?

Q13. What is your (respondent) Education?

Q14. What is YOUR (respondent) Type of Occupation/Profession?

Q15. Which Languages do you know & are comfortable in?

Q15A. If Yes, in Vernacular Which language do you know?

Q16. What is your Monthly household Income? (Monthly household income I mean overall income whoever belongs to your family and stay at your home)

Q17. Do you do Grocery shopping for your household?

Q18. Which of the following durables do you have at home?

Q19. Do you do Online shopping?

Q20. Which Online Shopping Platforms do you use?

Q21. Do you Watch TV?

Q22.What is your Most Watched Type of Programme / Channel?

Q23. In Which Language do you MOSTLY watch TV?

Q24. Do you watch OTT? (Various Apps through which you can watch TV shows, Movies, Web Series etc.)

Q25. Which OTT platforms do you use?

Q26. Do you use Social Media Actively?

Q27. Which Social Media do you use REGULARLY (DAILY)?

Q28. Do you have Internet connection at home? (WiFi or Cable Line Or Dongle)

Q29.Who is your Primary Mobile service provider?

Q30. Personal finance: Which of the Following do you have/Use?

Q31. FMCG Products/Brandsused at Home

Daily Consumables

Salt

Flour

Pulses

Atta

Besan

Spices

Dairy Products

Butter

Cheese

Milk

Dahi

Ghee

Paneer

Ice Cream

Bakery

Biscuits

Packaged Cakes

Cookies

Confectionary

Chocolates

Candy

Snacks

Chips

Namkeen

Raedy to Eat

Ready to Eat

Toiletries

Soap

Shampoo

Hair Oil

Toothpaste

Beverages

Soft Drinks

Juices

Hard Drinks

Q32. Do you order Foods Online?

Q33. Please mention which food ordering app do you use?

Q34. Do you Go out to Eat?

Q35. With whom do you go out to Eat?

Q36. How frequently do you Eat Out?

Q37. How frequently do you go for Holiday?

Q38. Do you go to Gym?