Survey - Cancellation

1

Name* This field is required.

First Name

Last Name

2

Have you had a chance to discuss this cancellation with your adviser?* This field is required.

Yes

No

4

Are you replacing your old policy with another provider?* This field is required.

Yes

No

5

Are you moving your mortgage to another broker/institution?* This field is required.

Yes

No

6

Reason for cancellation/transfer* This field is required.

Can not afford it

Not happy with the services

Better deal with a lot more benefits

7

Did your adviser discuss the benefits that you may forfeit or any risk which you might be exposed to in cancelling your cover from us?* This field is required.

Yes

No

8

Did you adviser explain the difference between your current policy/mortgage and your new replacement policy/mortgage?* This field is required.

Yes

No

9

How can we further improve our services?* This field is required.

10

Would you still like to receive our monthly newsletters?* This field is required.

Yes

No