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Questionnaire

Location: ____________________________
Household ID: __________________________
Contact: _______________________________
Name of Surveyor: ______________________
Date: __________________________________

Section A: Personal Information

Name:
Age:
Education: Illiterate/Primary/SSC/HSC/Graduation/above
Marital status:
Number of children:
Children educational status: Illiterate/Primary/SSC/HSC/Graduation/above
Monthly/yearly income:
Sources of income:
Property:

Section-B: General Information of the Enterprise

1. Name
2. Nature (i) Cottage (ii) Micro (iii) Small (iv) Medium (v) Others
3. Sector (i) Trading (iii) Manufacturing (iv) Service (v) Farming (vi) Real Estate
(vii) Export (viii) Others
Type Handicrafts Parlor Boutique Cloth Grocery
Stationery Agro-based
4. For how long has your company been in operations?
(i) Less than 1 year (ii) 1 - 5 years (iii) 6 - 10 years (iv) 11 -15 years (v) Over 15 years
5. How many people are employed by your company?……………………………………..
(i) Less than 15 (ii) 16 – 30 (iii) 31 - 50 (iv) More than 50 No:
6. What is the amount of capital/investment/asset value of your enterprise?
(i) Less than 10 lac (ii) 10 lac- 75 lac (iii) 75 lac- 2 cr (iv) More than 2 cr (v) Others
7. What was the highest amount your company ever borrowed from a Bank/MFI/MFS?
(i) Less than Tk 10 lac (ii) Tk10 lac to Tk25 lac (iii) More than 25 lac Amount:
8. Do you have professionals in managerial positions in your company? Yes No
9. What is the qualification of your management team?
(i) SSC (ii) HSC (iii) Degree/Honours (iv) Masters (v) Others
10. Does your organization have any business plan? Yes No
11. What is the average monthly turnover of your business?
(i) Less than Tk15,000 (ii) TK15,000 – 25,000 (iii) TK25,000 –35,000 (iv) Others
12. Your Category: (i) Banked (ii) Unbanked (iii) NGO member
13. If you are unbanked then how do you receive financial services?
(i) Mobile Banking (ii) MFI (iii) NBFI (iv) Cooperative (v) Other
14. Has your farm ever applied for credit from a Bank? Yes No
If no, why?
15. (i) Interest Rate is high (ii) No collateral to pledge (iii) Formalities (v) Other
16. Have you ever been refused or denied credit from a bank? Yes No
17. What was the main reason your bankers refused offering you loan?
(i) Default on previous loan (ii) No Security to pledge (iii) Too small equity base
(iv) Lack of Necessary Documents (v) Lack of Business Plan (v) Others (Please specify)
18. What was the purpose of the loan?
(i) Startup capital (ii) Working capital (iii) Expansion of business (iv) Other (specify)
19. What information did your bank asked for?
(i) Collateral (ii) Cash flow statement (iii) Total Assets (iv) Business License (iv) Other
20. Have you ever had problem of repaying a Bank/MFI loan? Yes No
21. If yes, what factor created the problem?
(i) Short duration (ii) High monthly repayment amount (iii) High interest rate
(iv) Low turnover (iv) Other
22. How did you find the lending rates?
(i) Extremely High (ii) high (iii) Acceptable (iv) Low
23. What percentage of interest is on the loan?
(i) Less than 20% (ii) 21 – 30% (iii) 31‐40% (iv) Above 40%
24. What are your sources of funding for the business?
(i) Bank loan (i) MFI loan (iii) Personal savings (iv) Retained profits
(v) Trade credit (vi) NBFI (viii) Family/friends (ix) Other
25. What are the major constraints to the growth of your company?
(i) Lack of finance (ii) Competition (iii) High interest rate (v) Taxes (v) Other
26. Do you have any Mobile Financial Service (MFS) account? Yes No
27. If yes, mention their name
(i) bkash (ii) Rocket (iii) Nagad (v) UPay (v) Other

Section-C: Women Empowerment

For the sections below put a tick mark on the options from 1 to 5 indicating 1 as strongly disagree
2; disagree, 3; neutral, 4; agree and 5; strongly agree.

Economic Freedom:
1 I can earn my living independently 1 2 3 4 5
2 I can take decision on my income
3 I can take decision to spend without interfere
4 I can and manage my money by myself
5 I can purchase asset by own name
6 I can decide about my savings
7 I can buy jewelry independently
8 I have access fund from institutions
Household management: (ASSETS)

1 I can decide to buy household 1 2 3 4 5


2 I can decide to sell household
3 I can take decision on family matter including child’s education,
marriage
4 I can decide household loan spending
5 I can take decision on land equipment selling
6 I have control on my asset
7 I can buy clothes or other essentials for myself without permission of
my husband

Perceived status within household:


1 I am recognized as decision- maker in family 1 2 3 4 5
2 My status has been increased in family
3 My status has been increased in society
4 I am known with my identity
5 I enjoy equal treatment and consumption in family
6 I can visit relatives house freely
7 In case of abuse or violence, I can seek legal protection
8 I can legally divorce my husband, if necessary

Education and educational freedom:

1 No barriers in my education 1 2 3 4 5
2 I can move for obtaining any higher degree
3 I have opportunity for technical education
4 I enjoy invitation from various training program

Health:
1 I can take care my health 1 2 3 4 5
2 I can take proper medication in illness
3 I can visit expert doctor for treatment
4 I can decide anything about using birth control measures

Politics:
1 I can decide my voting rights 1 2 3 4 5
2 I am a member of local government
3 I am currently engaged in organization/politics
4 I can participate in local elections as candidate
5 I am a member in school management committee

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