1. Has any member of the Household been affected YES/NO physically by the floods or the landslides . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. If “YES” state the nature of disablement: . , . . . . . . . . . . . Sex: . . . , Age: . . . . Number: . . . . . 5) Loss of human life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii) Physically hadicapped . . . . . . . . . . , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, Give details about the mishap: . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Has the Household experienced any loss in YES/NO 