1. What is your country of residency?
2. What is your age group ?
17 and under  
18 - 25  
26 - 35   
36 - 45  
46 - 55  
over 55   
3. What is your gender?
Male  
Female  
4. Please choose your highest level of education achieved
None  
Primary  
Secondary   
BA / BSc / Technical   
MSc / MBA / MPhil  
PhD  
5. 

Do you have a cell phone?

If your answer is NO , please go to Question 8.

Yes  
No   
6. 

Is your cell phone a smart phone? 

(A smart phone is a mobile phone with features that enable it to easily download and use apps, access the internet and send emails).

If your answer is NO, please go to Question 8. 

Yes  
No  
7. Do you access the internet/apps on your smart phone?
I do not have access because I have no data or wifi access  
Never  
Seldom  
Once per Week   
Every Day  
8. How much cash in hand do you typically carry?
$1 to $49  
$50 to $99  
$100 to $199  
$200 to $499  
$500 to $999  
9. 

Do you have an account with a domestic financial institution in your country of residence ?

If you choose NONE , please go to Question 16.

Commercial Bank   
Credit Union  
None   
Other ( Please specify)    
10. Do you have any of the following and have you used it (them) in the last month
 PossessionNumber of ItemsUsage in past month 
Debit Card 
Credit Card 
Credit Union Debit Cards 
Store/Branded Credit Cards 
Checking Account 
Online payment Accounts eg. paypal 
E-wallet (google, apple etc) 
Other (please specify)
11. How often do you use the ATM to withdraw and/or deposit cash and/or cheques?
 DailyWeeklyEvery two weeksMonthlyQuarterlyAnnuallyNever
Withdraw Cash
Make Deposit
12. For what reasons do you typically withdraw cash from the ATM?
 Reason of UseProportion of withdrawals from ATM ( per cent ) 
Paying for purchases (goods and services) 
Paying bills 
Topping up cash holdings 
Cash Gifts 
Other (please specify)
13. How often do you go to the bank to withdraw and/or deposit cash and/or cheques ?
 DailyWeeklyEvery two weeksMonthlyQuarterlyAnnuallyNever
Withdraw Cash
Make Deposits
14. Please tell us the payment method you most prefer to use for making in-person purchases
 Payment Methods
Less than $10
Between $10 and less than $50
Between $ 50 and less than $100
Between $100 and less than $500
Between $500 and less than $1000
Between $1000 and less than $5000
$5000 or more
15. Approximately, what percentage of your purchases in a month are done using the following?
Percentage
Cash
Cheques
Credit Cards
Debit Cards
Prepaid / Gift Card
Bank account number payment
Standing Order
Online banking bill payment
Mobile Banking
Money Order
Travelers check
Paypal type account
E-wallet
16. For each type of business listed below, please indicate the method of payment you are most likely to use
SectorExamplesPayment Method Type
Financial services providerCredit card companies, mortgage companies, insurance companies, mutual funds, credit union
Money Transfer OrganizationsRemittances
Education providerSchools, university, child care
Medical care providerHospital, doctors, dentists
GovernmentTaxes, Fees
TransportationBuses, taxi, maxi
Utilities Electricity, water, cable,
A PersonFamily, friend, helper
Retail Store (A)Grocery, pharmacy, clothing store
Retail Store (B)Gas Station
Retail Store (C)Restaurants
Online storesAmazon, Netflix
Non-profit/charity/religiousCharitable or religious donations
Building servicesConstruction, electrician, Plummer
General ServicesHair dresser, dry cleaning, auto repair, parking
Professional ServicesLawyers, accounting
17. Please rate your experience/perception of each payment method
Security – suppose a payment method has been stolen, misused or accessed without the owners permission, please rate the security of each method against permanent financial loss or unwanted disclosure of personal information.
Acceptance – Please rate how likely each payment method is to be accepted for payment by stores, companies, online merchants and other people or organizations.
Cost- Consider for example fees, penalties, interest paid, cash discounts.
Convenience – Consider for example, speed, control over payment timing, ease of use.
Setting up – rate the task of setting up each payment method before using it, for example getting cash from ATM, paperwork, learning to use or install.
 SecurityAcceptanceCostConvenienceSetting up
Cash
Cheque
Credit Card
Debit Card
Prepaid/Gift cards
Bank account number payment
Standing Order
On-line banking bill payment
Mobile banking
Money order
Traveler check
Paypal type account
E-wallet
18. In the future are you likely to use less cash?
Yes  
No  
19. If YES to question 18 , can you indicate the reason(s)
 Reasons
Social trend away from cash
Cashless payment will become/is more widely accepted
Cashless payment will become/is simpler
Cashless payment will become/is quicker
Cashless payment will become/is more secure
Cashless payment will become/is even more integrated in the payment space
Cashless payment will become/is cheaper
No reason
Other
20. If currency/cash in circulation were significantly reduced, would this impact you adversely?
Yes  
No   
If you choose Yes, please state how   
21. Have you heard about digital currencies?
Yes  
No  
If YES, which one ? eg. Bitcoin, Ethereum, XRP, Litecoin, etc.