Personal Accident Survey

Guardian Group Incorporated Agent: Alafia Whiskey
(C) 378-4666 (O) 294-7587
(E) alafia.whiskey@myguardiangroup.com
(E) admin@iwantprosperityplus.com
(W) www.iwantprosperityplus.com
Address: Sean David Branch, Guardian Life,
9-13 Endeavour 1st Street, Endeavour Industrial Estate, Chaguanas
Fact Find Date:*

DayMonthYearHourMinutesAM/PM Option
Personal Accident Survey
Why do you work? What motivates/ drives you? Your Goals?
What main sources of income are you dependant on?

SalarySavings/InvestmentBoth
What are your basic necessities?

Food, Shelter, ClothingFood, Shelter, Clothing, Education, Entertainment
If you were to become disabled or experience an accident, and cannot work, who would take care of you financially?
How would you pay your bills and look after your family if you couldn't work because you had an accident and were badly injured?
What percentage of your salary is still needed in the event of an accident or disability?

How challenging would it be to maintain your current standard of living while having to face the monthly expenses associated with an accident?

	1	2	3	4	5

1 is Not Challenging, 5 is Very Challenging

How long can you maintain your lifestyle in the event of a disability today?

1-3 months3-6 months6-12 months12-18 months18-24 months24 months +
Are you satisfied with your current Disability preparedness?

YesNo
Praesidia - Our Personal Accident insurance product that gives prime protection in the event of a serious incident – accident or illness. Want to find out more? Select all areas of interest below

Income protection and a disability Income benefitHealth Cover (due to accident or sickness)Hospital Surgical ExpenseTerm Life Coverage (optional)Accidental Death and Dismemberment Rider which covers both injuries and deathHospital Cash benefit pays you cash when you or your family are hospitalizedCancer CoverageCoverage for spouseSpecial Spouses Annuity - benefit is either paid in streams or lump sum.Coverage for more than one life insured on the same policy will be available under this product
How much money monthly can you allocate to addressing these concerns?

< $200$200-$400$400-$600$600-$800$800-$1,000$1,000Other