--llliilllil ... illlil Royal Government of Cambodia

ll'liJll[dliillli Ministry of Planning

iift1ilillO ...... ~:illiDl1UJ.ilill61fi 1!11 gg

2011 Economic Census of Cambodia

Form (draft)

mlniith,aa STRICTLY CONFIDENTIAL

iiiinuc~~-~rpe This is used only for the statistical purposes and not used for taxation. p\15g fuililJj'IUoo

As of !st March 2011

1- l\iiHiiDUlidftli Area Information - Area • Name .Code

1-1 l&lii/lil! Municipality /Province

1-2 • ..,, !UJll District/ Khan/ Krong

1-3 .. , .. Commune/ Sangkat

1-4 p111p Village/Mondul

1-5 •.,,..oil Enumeration Area (EA) I I 2-A l\iie•lilUlljlllil Establishment Information

EA Serial Number of Establishment in village or EA ;--····-··-------· .. -··-~ ......................... , ...... -... -.. . i {

' (from the "Establishment List") l '

2-3~ IHIOlil Street No. I IJilllm Building No. __ !!_ ____________________________________ _J Address of establishment lll!f~Name of.Market, Name of nearest household etc.

&dll!ilinliim Office Tel No. , ...................................... . ....... 1_N_a_m_e_o_f_co_n_ta_ct~p'-er_s_on_: ____ __, !:I:~?:.<>r<:<>l1.t.~ct_p~r:5{)1:1= .... Information for contact

2-B WJliililillDilll/ilii Interviewing Situation

D - .. .!.I RL,1\. ... 1*!11 Filled-in by Enumerator/Supervisor IN' ..

illllf~limim!!)llMiuf1 Final Date of Form Survey

Date of Finishing Survey

pnm...-aiili 1-iiaqrpi D l I

2-~ 3- liilliB 4- liilliB

Type of Survey Result UWlm Complete refusal ~ ....... Name of ARO: ................................................. .

flill!l1111¥ Circle the code Finished ! Serious refusal Minor refusal ......... ~.-.-·-ii Signature ................................................. .

Date of handing "Special Survey List" to ARO

Jl!P=tl..- Enumerator's Name: ................................................. . ... .............. Checked by Supervisor: .......................... .

ifllli\.OiiDate: ... ... ... ... ... ... ... ..... ... llplllillSignature... ... ... ... ... ...... illlli\.l'liDate: ... ... ... ... ... ... uplllillSignature ............................ .

-1-

3- IDilrumiilUJi lliltilDlllllll U~lilUltpllil Characteristics

of representative or Owner of

the establishment

3-1~ Sex of the Representative

3-2~1dJV11l Nationality of the Owner

1- lllil Male 2- Jiil Female

1-~ Cambodian 2- IJllDlilil Foreigner

po .... specify nation~

4- m111:urii1111Jlrilnlli'ilil0 ill 1nojU'liJll u w

lllUf!piHl§IUl'f' Registration to administrative agencies and Names of Ministries or

agencies regarding license or approval of operating

1- liJli\EUU 2- ililiJli\EUU Registration to the Ministry of Commerce or Provincial Department of Commerce Registered Not registered

4-2 "!'Eli¥'.P l!'iifilfF::J&llllJI~ illllll*P"- ildiml ~1~ Names of Ministries or Agencies regarding official

1-

license or approval for the business operating of this Establishment. 2-

- --..-.;iin1n1~:.~IB ~-v--.:::-un:r :.::..--m-~~-~~ --.. ·----~ Pillillllllil" Jlli" UilJ~g 3-

In case of no official license or no approval, write "None" in the right frame No. I 4-

s -i1U16liHl_glgJ11 lilUILilllil mtmiiiliflllli Ownership of Establishment (Legal status) w

1-~DI ..... Individual proprietor 2- ~li!JiSole proprietor 3-~ng..ei (Blillli\EU(iwith no registration ) ClilifUWwith registration) General partnership

4-~li!JDilii 5- ................... 6-JPiptnm~ Limited partnership Private limited company Public limited company I 7-~llWilil 8-~ 9- ~tprifliloail

Subsidiary of foreign company Branch of foreign company Commercial representative office of foreign company

10- lillnn'i 11-~ State-owned organization 12- HplDUIWi6111 13-lillVlilflll::J

Cooperative YH~Including autonomy-owned organization) NGO Others

6- HiimmBllll iipnllilrupt uGlm. 1- ...... 2- .......... 3- lillill

I Single unit, Head or Branch office Single unit Head office Branch office

7- nllilllii111iiin£11• tplilli iii flU''l)liin£iillllBinu9...: Tenure, Kind and Area (square meters: m2) of business place

7-1 ilnnfiilliii~ 1- i!liigllfp 2-p 3-up::JUpl

I Tenure of business place Owned Rented Others (approved)

7-2 tplillii 1-~ 2-~-. l.W 3- ~-llillllliiJP-I 4 -rili!inm .. llld ~ -•r ..-.~ [~~ Business in traditional

Kind of Street business rl,plilu•I Home business iiDlltJ1 Business in apartment market u .. ..,.....,..

business place (Business place, its owner's building ( Business place and its Hi'lllill (including market

residence are united into one) Owner's residence is separate.) in low-rise building)

5-rili!jilll ...... [llillijfir.Jlintni 6-~~ ............. , ... 7-up::J I ... ....-.~~ ,..-......q ............... Others

Business in modern shopping mall (high-rise --01111 Business that is occupying

building where multiple establishments are exclusively one block or one building Ex: Factory,

operating) Bank, Hospital, School, Pagoda etc.

7-3~11, 1- ~- id- J- .;- ~- ,J-~ I JUllll 5 II 511 -w 109 -w 3011-~ 50tl -1(.ftJI, 10011 -•ljllL 200 ti lii'JUI

Area of business place 10 ti 30 ti 50tl 100 II 200 ti

(square meters: m2)

200m2 and more J Under5m2 5m2-under !Om2-under 30m2-under 50m2-under I 00m2-under I 10m2 30m2 50m2 !00m2 200m2 uwnspecify c:::> 1

-2-

I

I

I

I

I

I

8-lHiuU~ Opening time lii'llo'clock Iii; minutes

Business Hours 8-2Hhiili~

Closing time lii'llo'clock Iii; minutes

9- ,e'itlllitf!pllliliiilH~ Year of starting the business

.... dlli Circle either of 6""""'V"

1- PAM 2- !!16PM

Circle either of

1- tfnAM 2- !!16PM

- Persons 1~- ti95&1119nt.mmanililrifo1.Ji!!lilillllUnlil 'illil.t.11\,, g9 g £i; iiilil !fl l!O IJIJ Number of persons engaged actually in this establishment one ~-----~---~=~----~------------o

.,, 1- iiplTotal • Nationality lil9 Sex

week before 1 March 2011.

~ ililiinii.uinnitili&nri& ~·iE&.--HSL-ulil IU =II' Y, °'- d' U g-';l·gu-

~~:il..-rm ~In case of"head office" (Question 6.), all persons engaged in its branch office are excluded.

10-Al !!ippinlo ........ imil

Self-employed proprietors, sole proprietors

Unpaid family workers

10-A3 '!,.iWfn.,.~Dti(!!iUlw.\l~ffniltem£~ Regular employees (those who are employed on a continuous basis with more than one month eriod

10-A4 ~illl~fl!O [1(.~~fil other employees than "regular employees"

10-B !!ippiRl."D~ii'f1 [(.O:liQ llDiJ ~"Dt) iilDiu'I° luaJ~ ...... liVoluntarily-engaged persons (monks,

cler man etc, excludin Chief who controls the Or anization.

11- IJllillilililH!mlllilii11ujuu£11mlilUIJjlllill)liiUiiJrn1 . . Kind of main business activities which this establishment only is engaged in.

1=2+3

Jlor 1=4+5

~ J.B~~jRilri:lj'j (ii- illDIB@t nli(l_!I llliiilu) ~nspi{iU JI~) Describe what are done in this establishment. For example, selling (to wholesalers or consumers), manufacturing or repairing goods, or providing services.

~ \\Bmiilill.~ ~Dlui: Describe kind of these goods or services also.

~~ili&nri&~'niuii . --··. -· - -..-~.JllllilllildilUI In case of "head office" ( Question 6.), all activities of its branch

offices are excluded.

2-~ 3- fililUlilil

Cambodian Foreigner

~ "-" Ul!Pi~iiulri: iiHBl~muimB "Branch Office" finishes to fill-in. No more answers are necessary

l2-ti9111lillrillmijillli1lljlWlilll(jlllljlllU1fii9pmmruumui: Number ofBranch offices that this head office supervises

4- Ullil Male

13-UiliilillilDmillillilllililillli\,UolwrdlillllUlllilUiliitund['il Iii 1!11 g(J Total number of entire regular employees at the end of December 2010

~ .. , ci -. I .. ·.- &rim 't . r·· an ·-.. ,_ I --lfiwii9·· I + .... This "entire regular employees" includes not only those of this head office but also those of branch offices (namely,

"Head office+ Branch offices")

-3-

s-1.ru Female

14- LDlil5lililH~ilH~UllmliilillD(jlllilli'i11ftru un111u0umru5i1nmpi11ii1lll!JID iilHillin Kind of business activities of the entire w w =-

enterprise that include not only those of this head office but also those of branch offices (namely, "Head office+ branch office")

14-1 l.~Wllmliililf\,DU Kind of main business activity

.. ...~Upilitgnimmijl ~jnlh"lllJlmtil Select the main one in terms of the largest value added or largest manpower input

14-21.~wliil!~niBil~l!J!lliPi Kind of second main activity in case that this establishment has two or more kinds of activities

16- iinuruiimami DIUlllD1JlliUi\Jlli iiliD91j g1gi111Qlifo i}ti::J !fi 1!11 gg 'I 1JlfiililiiOllQIDDillDUii iillDIUlllllLDliUi\JlllQllfo 1tti::J !fi 1!11

ii11f!llliillllliil11 Uf&tim!!)finuruiimauri iiliti1U111111J1liuli.r1iall<.J(ilil1111H11 -. 11miililmun1i11iliipmu11119rum&11riu1liinurud'mauri iili DlllnDLUiiuii.rllli'ili!ru ,Jllli'ilililliHdllfllli Amount of sales and operating expenses and number of working days in February 2011. If the amount of

the February is unclear, those of past one month must be filled in. In case of Head office, total amount of sales and operating expenses including Branch

offices must be filled in.

16-1 itgnmilipl..VUIJ(il lfif-.,: jl!llJIJ !_llJ( .... il tPilililiiilytoo(iiilillJllii- IPl.ill~IJ\!i Total amount of sales of one month in February 201 lor past one month. If the amount of one month is unclear, that of per day must be filled in.

_.. .. illu~iiu~~'1HH Includes every income gained Jtbm operating activities such as selling of goods, providing services etc.

16-2 mnumllipl,DlllJ illi!I: ,911!1 IJIJ !llJ ilf;Ulil tPfililHllllllllJ iiiliJPillllfiiWiim(jll11111119ilJ ,!! Total amount of e~penses of one month in February 2011 or past one month. If the amount of one month is unclea~ that of per day must be filled in.

_.. jllU . .Q Q • iiu~fimitmfininti UmJllllmiiftuipU ~~=;:;.~~'1HH Includes every expense being paid for operating ctivities such as purchase of material for sales, instruments for ll\-oviding services etc. rent for shops or others, and

m lo ee's salaries and wa es and so on.

16-2-1 .!JIHnnu~ ~llJIUViliifoTl\lilil!!! ....... !llllJfo Cit(.: !JII!i IJIJ ...

1Piiliu~maiit, ..... 11liii:ipiiuliijaa\ ....... maiit,~\!i u 'I u 'I

Among those described above, total amount of employees' salaries and wages of one month in February 2011 or past

one month. If the amounts of one month is unclear, that of per day must be filled in.

16-3 tp,!ijrtlilJllil'!I: !Jll!llJIJ !1,DlllJ(~il Number of working days in February 2011 or past one month • •

•t•i•mlim:ill[ in US$]

•Per month

US$

US$

.Per month

US$

(Cl l~Per day) us

•Per month" US$

(Cl ~Per day) US$

~days

.. ....... ani "~illii' .. "~' u.pUu¥m ·~umaiU Establishments with no

"Income Statement" finishes. No more answer is necessary.

17- 055150 lili1Hiilmtli1iiruntifo D nl 1!11 g(I lPW IJlll ,g iili 'llll .l!j u··u ,. -::.. !!I IA ..

Total amounts of assets at the end of December 2010 (Sum of 17-1 and 17-2)

17-1 lii'J~ilD:llllfill Non-current assets (fixed assets)

17-2 l.lilJ~ilD:umj Current assets (Ui:ii:lu~J9gl'lliJnJJ91d9This is not sum of 17-2-H 7-2-4)

9 17-2-1 lijit' ~:-gfl. Stocks ofraw materials and supplies

17-2-2 li!ff uHa_! Stocks of goods

of which) Stocks of finished goods 17-2-3 ii!ff ~;fl nventories

17-2-4 lilitl' liftfiallDliilll ... fi•ai l!!9 II ... -u--~ Products in progress

-4-

Al

Al3

Al4

Al5

Al6

Al7

US$

US$

US$

US$

US$

US$

US$

18- 11miiiiu111innui fa JI ~ 1!11 IJll Equity held at the end of December 2010

~8-1 _,- pua ~ (of which) Capital/ Share capital

Non-current liabilities at the end of December 2010

20- u1U1mau::mm~ti fa n m 1!11 IJll ~ !!II m

Current liabilities at the end of December 2010

21-1 : a 32 I WJperating revenues [ .... l!llB& lllil!!llBDI (Sum of21-1-1to21-1-3)

21-1-1 ilDllDiDlu Sales of manufactured products (~iDllfiml

21-1-2 ~ Sales of goods (~~

21-1-3 nmdalilil .... Sales/Supply of services ( ....... lidl

21-2 ..,.,.T .. Wlotal ofOperating Costs [ .... 1!!111!11 lllil!!lll!Jlll (Sum of21-2-1 to

21-2-3)

21-2-1 lpitl~~ Costs of products sold of production enterprises

2 l-2-21pm~-...iil9ia\.~ Costs of goods sold of Non-production enterprises

21-2-3 lditllliliWUir"li DJ ....

Costs of services supplied

21-3 i a F Other revenues [ .... l!!llmB llil!llmlJIJ) (Sum of21-3-1-21-3-11)

21-3-1 IJJ_iWD:i Subsidy/ Grant

21-3-2 ~Jllifl¥U Dividend received or receivable

21-3-3 ftenDmL.-....JI JAlll Interest received or receivable

21-3-4 ~Jllifl¥U Royalty received or receivable

21-3-5 ~JllPPI Rental received or receivable

21-3-6 ~~ QD:IJllfm Gain from disposal of fixed assets (capital gain)

Gain from disposal of secw-ities

Share of profit from joint venture

Realized exchange gain

Unrealized exchange gain

21-3-11 npdwjilll..nliilftiii Other revenues than those described above

-s-

US$

A29 US$

l A36 US$

A41 US$

BO US$

Bl US$

B2 US$

B3 US$

US$

B4 US$

B5 US$

B5a US$

B7 US$

B8 US$

B9 US$

BIO US$

Bil US$

B12 US$

B13 US$

B14 US$

Bl5 US$

Bl6 US$

B17 US$

B18 US$

21-5

21-6

21-7

21-4-1

21-4-2

21-4-3

21-4-4

21-4-5

21-4-6

21-4-7

21-4-8

...... J.~lililpJ Salaries and wages

r..u..u-11 ¥eld1ifil Fuel, gas, electricity and water expenses

m....jiltihi~ Travelling and accommodation expenses

~ Transportation expenses

illmmimmu Rental expenses .. ~ .... Repair and maintenance expenses

~ Entertainment expenses

ilummiUiilaflilimRllnnmi"&HI ~Commission, advertising, selling expenses -.---..--=-Other tax expenses

21-4-10 iluuUiHnmu Donation expenses

21-4-11 U....O.lil\,mi(.i&lil(.m:llDllni UV-aiilhlil\,IDDitJllim Mana ement, consultation, other technical, and other similar service ex enses

21-4-12 --~ Royalty expenses

21-4-13 immminptmiililili Bad debts written off expenses

21-4-14 ilumilaii Amortization/depletion and depreciation expenses

21-4-15 nm'iWi'Ji_!IOD\lliiitfiSi Increase/decrease in provisions

21-4-16 ~HJ~illl:lmiill Loss on disposal of fixed assets

21-4-17 iDiDmlqJftiiUilli Realised exchange loss

21-4-18 ~11.lftifB'iftliilili Unrealised exchange loss

21-4-19 ....... Other expenses

• Interest expenses paid to residents

zyWw 7 - Interest expenses paid to non residents

....-..m Profit tax

823

824

825

826

827

828

829

830

831

832

833

834

835

836

837

838

840

841

843

Checked by enumerator tJiut.i1ii Correct IJlilRiitJiut.•~ !fit is Correct, circle this

~wmmrn~-..i1ii u

I certify that information filled-in the form is accurate

Issued at.. . ......... Date ................ .

Signature/stamp of Establishment Owner/Manager

-6-

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$