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Questionnaire No: Date: Name: Address
Questionnaire No: Date: Name: Address
NO: DATE:
NAME:
ADDRESS:
Male
Female
10. In which company you would like to purchase Health Insurance Plan
Government Health Insurance
Public Ltd Health Insurance company
Private Health Insurance Company
Foreign based / MNC Health Insurance
15. Do you think your Health Insurance premium rates are reasonable
YES
NO
16. How happy are you with the choice of Health care providers in your current plan
Highly Satisfied
Satisfied
Not Satisfied
17. How satisfied are you with the outcome of your claims
Highly Satisfied
Satisfied
Not Satisfied