MARKET SURVEY - CRITICAL ILLNESS

1st Column

Name

Occupation Contact No

Age Group Below 20 20 - 29 30 - 39 40 - 49 40 – 49 Above 50

Marital Status Single Married without kids Married with kid(s) Single Parent

2nd Column

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

We are currently conducting a survey to create the awareness on critical illness to the public. May I take 3 minutes of your time to
ask you a few simple questions?

1 Do you agree that compared to 10 years ago, more and more Malaysians are suffering from critical illnesses such as heart
attack, stroke and cancers?

Yes No

2 How much do you think is the medical cost to cure a critical illness in a private hospital?

About RM20,000 RM20,000 - RM100,000 Above RM100,000

3 What do you think is the best way to pay for this medical bill?

Own Saving Borrow from relative / Friends Donation Insurance

4 If I could show you a way that can instantly provide RM50,000 and preserve your money in savings, would you be interested to
know more about it?

Yes No

5 I just need 20 minutes from you to explain the Power of RM10. Would you prefer to meet on a weekday or weekend?

Weekday Weekend

3rd Column

Just one last question. Can you name any 3 persons whom you think could also be interested to know about this benefit? May I have
their names and contact numbers please?

1. Name Contact No.

2. Name Contact No.

3. Name Contact No.

This market survey is conducted by:

Name Date

Agency Leader Name MOHD NAZRI BIN MOHD NASIR Introducer Name

Agency Name KL NAZRIZZ GROUP Region CENTRAL Branch AIA CAPSQUARE

AIA Elite Academy | Rev03 2017/02/01