SEPTEMBER IS LIFE INSURANCE AWARENESS MONTH
ONLINE QUESTIONNAIRE FOR NORTH AMERICA
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
example@example.com
1. Which kind of LIFE INSURANCE plan do you have ?
*
Term Life Insurance
Whole Life Insurance
Index Universal Life
Group Life - from my job
I do not have any
Other
Do you understand how your life insurance policy works ?
*
Please Select
YES
NO
When was the last time you reviewed your life insurance policy ?
*
2. Do you have more than one type of life insurance ?
*
YES
NO
3. Do you want to know more about different types of life insurance plans and how they work ?
*
YES
NO
4. Why do you have a life insurance policy ?
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To protect my money from market volatility
Tax - advantage
Estate planning
Supplemental income at retirement
Income protection
Other
5. Who is the beneficiary of your policy ?
*
I can benefit from my own policy
Only someone else can benefit from my policy
I do not know
6. Are you open for a "FREE" policy review ?
*
Please Select
YES
NO
7. You may upload copy of your current policy statement or illustration (optional)
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8. These are my best availabilities
*
9am - 5pm. Monday to Friday
9am - 5pm. Saturday and Sunday
5pm - 10pm. Monday to Friday
5pm - 10pm Saturday and Sunday
Other
9. What is the name of the person that sent you this survey ?
*
Please verify that you are human
*
Submit
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