Questionnaire

Name of the head of family:__________________________

Education:________ Occupation:_______
Age:_________ Sex(M/F):_______
Residential Address:_____________________________________________
_____________________________________________
Age (In years) No. of Persons
________________________
Male Female Total
___________________________________________________

Below 5
5-14
15-64
65 and above
_________________________________________________________
Total:
Level of Education
No. Of Persons
________________________________________________________
Illiterate
Primary
Secondary
Graduation
Others
__________________________________________________________
Total

Monthly Income
( In Rs/-)
_________________________________________________________
Up to 1000
1000-5000
5000-20000
20000-50000
50000 and above
__________________________________________________________
What do you use to clean your teeth ?
Toothpaste_____ Tooth Powder_____ Any Other______

Which brand of toothpaste do you use regularly ?

Aquafresh___ Cibaka____ Anchor_______

Close-up____Promise_____Pepsodent_____
Oral B_____ Furhans_____Any Other____

The price for 100 gram pack of the toothpaste (used by them).
Price_______(actual)
Price________(approx.)
Do not know______.
_________________________________________________________________________
 Do you find the product costly? Yes/No
 Do you check MRP, date of manufacturing and date of expiry? Yes/No
 Do you check standardization of product like ISI, Agmark, ISO 2000 ? Yes/No
 Do you check ingredients used in the product ? Yes/No
 Are you satisfied with the quality of the product ? Yes/No
 Are you aware about the Fair Price Shop ? Yes/No
 Do you find the availability of product at FPS ? Yes/No
 Do you complain the shopkeeper in case of dissatisfaction ? Yes/No
 Has your complain been timely attended ? Yes/No
 Was your complain attended to your satisfaction ? Yes/No
 Are you aware about Consumer Courts ? Yes/No
 Have you ever gone to a Consumer Court in case of any dissatisfaction ? Yes/No
 Do you insist Cash Memo at the time of purchase to ensure genuine purchase and tax
revenue to government ? Yes/No
 Do you insist Cash Memo for other commodities at the time of purchase ? Yes/No
 How do you come to know about the product ? Yes/No
 Advertisement Family influenced
 _______________________________________________
 TV _______
 Newspaper _______
 Magazine _______
 Cinema _______
 Sales Representatives _______
 Exhibits Stall _______
 Radio ________
 Any other ________
 _______________________________________________

 16. Are you attracted by promotional offers like rebates, free toothbrush, buy one get
one free? Yes/No
 17. Do the Children influence purchase of particular toothpaste? Yes/No
 18. If a new toothpaste brand is launched in the market will you buy it?
 If yes, then what consideration? Yes/No
 Price of the Product________ Quality of the product______
o Promotional offer_______ Any Other______