Name:------------------------------------------------------------Sex: male female age :----------------------------

Annual income:

Q1) Do you have any kind of insurance? a) Yes b) no

Q2)Can you tell me different types of insurance you currently have? Life insurance Term insurance Endowment insurance Personal accident insurance Money back insurance Unit link insurance plan All of them Q3) Please tell how well are you covered with your insurance plan? Definitely well covered Probably well covered Not well covered Probably not well covered Q4) How long do you think the death cover amount will cover your family ? 1-3 years 4-7 years 8-10years 11-15years Mortgage protection insurance Retirement plans Medical insurance whole life insurance Auto/Car insurance Travel insurance

Q5)Now thinking of all personal insurance policies you currently have how much in total are you covered for medical and life insurance excluding all other policies? Less than 50,000 50,000-100000 100000-500000 Above 500000 Q6)How much are u covered in other policies excluding medical and health insurance? Less than 50,000 50,000-100000 100000-500000 Above 500000 Q7)What type of insurance plan would you like to get for yourself ? ---------------------------------------------------------------Q8)Do you wish to participate in group insurance provided by your association? a) Yes b) no c)unsure

Q9)If yes do you want a)best money can buy b)middle of road c) low cost coverage

Q10)What are the reasons why you do not own any insurance? Its too expensive Insurance is not important I do not trust insurance companies Insurance is not worth investing

It is too much hassel to get

Q11)Were you satisfied with how your claims was settled so far ? If no explain y ?

Q12)If you have any existing policy with any insurance company as life assured, assignee,proposer please mention the details below: Name of insurance company:--------------------------------------------Name of insured: -------------------------------------------Sum assured :-------------------------------------- --------Yearly premium amount :---------------------------------------