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  Dark Figure of Crime Survey  
   
  1 Age    
       
  2 Sex    
       
  3 Locality where repondee lives    
       
  4a Date of offence Year  
      Month  
      Day  
       
  4b Time of offence    
       
  4c Location of offence    
       
  4d Street/area (approximate area or street name if known)  
       
  4e Where is this area    
    Other (specify)    
       
  4f Type of offence (Main category) and (Sub-category)
       
  4g What did you do?    
    Other (specify)    
       
  4h Did you call the police?    
       
  4i If yes, what was the result    
       
  4j If no, what was the reason for not informing the police  
    Dealt with in another way (specify)    
    Other (specify)    
 
  5i Was this your first case?    
       
  5ii If not, how many other times where you a victim    

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