Application Form
Hey there! I'd love to be a part of your financial journey.
Name
*
First Name
Last Name
What's your date of birth?
*
-
Month
-
Day
Year
Date
Do you have an email address?
*
example@example.com
And to end this section , do you have a contact number?
*
Please enter a valid phone number.
Let's move on
What's your occupation?
*
Are you permanent or temporary?
*
Please Select
temporary
permanent
How long have you been working there?
*
Please Select
less than one year
1-2 years
2-5 years
more than 5 years
What's your monthly income?
*
Please Select
less than 5000
5000-8000
8000-10000
More than 10k
Moving on to goals...
List your three main goals right now
*
Do you actively save?
*
Please Select
Yes
No
I try
How do you feel about insurance?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Do you have personal insurance?
*
Please Select
Yes
No
Set an appointment that best suits your schedule
-
Month
-
Day
Year
Date
DONE
Should be Empty: