月亮湾奖励性住房入住情况调查问卷Yue Liangwan Rewarding Housing Questionnaire

Dear all为了便于开展月亮湾奖励性住房相关工作，现进行入住信息统计，请您填写下方问卷，感谢配合！In order to facilitate the work related to the Yue Liangwan Rewarding Housing , we are now conducting occupancy information statistics. Please fill in the following questionnaire, thank you for your cooperation!

Q1:基本信息Basic Information

姓名 Name

房间号（例如XX栋X单元X室）Room number (e.g. Room X, Unit X, Building XX)

Q2:目前房间是否为您本人入住？Is the apartment currently occupied by you?

是 Yes

否 No

Q3:目前房间的状态是？What is the current status of the apartment?

闲置 vacant

亲戚使用 used by relatives

租赁 leased

其他 others（请填写状态）(please fill in the status)

:本人承诺上述信息真实有效。I promise that the above information is true and valid.