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  • Survey Form - Power of 10

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    S.V. Mohan
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    This document is a survey form about the power of RM 10 (Malaysian Ringgit) per day. It collects information such as the respondent's name, occupation, age group, and marital status. It then asks questions to understand how the respondent currently uses RM 10 per day, what value RM 10 holds for them, and if they would be interested in learning about an insurance product that provides coverage for RM 10 per day. It concludes by collecting referral names and contact numbers.

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    Power of 10

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    Survey Form

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    This document is a survey form about the power of RM 10 (Malaysian Ringgit) per day. It collects information such as the respondent's name, occupation, age group, and marital status. It then asks questions to understand how the respondent currently uses RM 10 per day, what value RM 10 holds for them, and if they would be interested in learning about an insurance product that provides coverage for RM 10 per day. It concludes by collecting referral names and contact numbers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views1 page

    Survey Form - Power of 10

    Uploaded by

    S.V. Mohan
    This document is a survey form about the power of RM 10 (Malaysian Ringgit) per day. It collects information such as the respondent's name, occupation, age group, and marital status. It then asks questions to understand how the respondent currently uses RM 10 per day, what value RM 10 holds for them, and if they would be interested in learning about an insurance product that provides coverage for RM 10 per day. It concludes by collecting referral names and contact numbers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SURVEY FORM – POWER OF 10

    NAME : ______________________________ DATE: ___________________

    OCCUPATION : ______________________________ CONTACT NO: ______________________

    AGE GROUP : 20 & BELOW 20 -29 30-39 40-50 50 & ABOVE

    MARITAL STATUS: SINGLE MARRIED WITH __ KID (S) MARRIED WITHOUT KID

    Hello! Good day. Is this a convenient time to talk?

    We are currently conducting a survey to understand the value of RM 10 from the public. May I have
    3 minutes of your time to ask you few simple questions?

    1. What can you do with RM 10 a day now?


    Buy 2 Meals 1 Pack of cigarettes Pay for Parking

    2. What is a value of RM 10 a day for you?


    Significant Moderate Insignificant

    3. If with just RM 10 per day you can obtain coverage for your life, critical & disability, would
    you be happy to know more?
    Yes No

    4. I just need 20 minutes of your time to explain the power of RM 10. Would you prefer to
    meet on a weekday or weekend?
    Weekday Weekend

    5. Final Question; Can you name of 3 persons whom you think could also be interested to know
    about this benefit? May I have their names and contact number please?

    NAME Contact Number

    1. __________________________ _____________________________
    2. __________________________ _____________________________
    3. __________________________ _____________________________

    I understand and agree that any personal information collected and held by AIA Bhd.’s authorised
    representative may be held and used for direct marketing and to communicate with me for such
    purposes. I understand that I have right to obtain access to and to request correction of any personal
    information held by AIA Bhd.’s authorised representative concerning me, and such request can be
    made to the respective AIA Bhd.’s authorised representative.

    Have a Nice day & Thank You!

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