START YOUR BRIGHTER LIFE TODAY!
Personal Information
We value your privacy. Rest assured, your personal data are secured and confidential.
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
Date
Occupation
*
Do you smoke?
*
Please Select
YES
NO
You are considered a "non-smoker" if you have not smoked at all for at least a year. Once a day, once a week, once a month or occasionally is still considered as a "smoker". Using vape is still considered as "smoking".
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LET'S PLAN AHEAD!
Congratulations for taking this step towards FINANCIAL FREEDOM. As your #PartnerforLife, may I ask a bit about yourself by filling out this short survey for the purpose of financial planning and to determine the best financial plan tailored fit for you.
How much Life insurance coverage do you want to have?
*
e.g. 1,000,000.00
What is your purpose of getting an insurance?
*
Emergency Fund
Income protection or Pamana Fund
Educational Fund
Savings for Milestone
Health Protection Fund
Retirement Fund
Mortgage Redemption Insurance (MRI)
Other
If others, please state here.
What's going on with your health right now, and what worries you?
*
Have you had any big medical bills and hospital stays before?
*
Please Select
YES, I HAVE.
NONE
Are you the breadwinner of the family?
*
Please Select
YES
NO
What are your big money goals in the future? Share your dreams and aspirations!
*
How can I better support you in your in your financial journey?
*
How much money are you willing to commit every month for an insurance policy?
*
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When is the best time to call you?
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