Annex 11 Inventory of Project Affected Assets (Sample) Province: ____________________ District: ___________________ Commune: ________________ Land to Loss of Survey Name of No. of Total Loss Temporary be Loss of Assets Loss of Crops Other Other Losses No. Head of persons Landholding as Losses Acquired assets Household in Hhold of Hhold in % of (specify) in M2 by Number Structures Structures Area of Fruit Eg., M2 total Type and type permanent temporary residential trees Paddy Other Tombs, Residence Business Income of lost (M2) (M2) land lost lost area (Specify) well, etc. (rented) Lost Loss structures (M2) Type (M2) (No. and &type) Number
Annex 11 Inventory of Project Affected Assets (Sample) Province: ____________________ District: ___________________ Commune: ________________ Survey No. Name of Head of Household No. of persons in Hhold Total Landholding of Hhold in M2 Land to be Acquired in M2 by Type Loss as % of total Loss of Assets Loss of Crops Loss of Other assets Other Losses Temporary Losses (specify) Number and type of lost structures Structures permanent (M2) Structures temporary (M2) Area of residential land lost (M2) Fruit trees lost Type and Number Paddy area (M2) Other (Specify) Eg., Tombs, well, etc. (No. &type) Residence (rented) Business Lost Income Loss