Life Insurance Awareness Survey
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1
Age of Responder
Select one answer
20-40years
41-60years
61 years and Above
2
Do you have Life Insurance?
Select one answer
Yes
No
3
3. Which Type Do You Have?
Select one answer
From Job/Work
Private Insurance
4
4. What benefits are in your Current Life Insurance?
Select one or more answers
Income Replacement
Sickness Rider – Cancer, Heart Attack, Stroke etc
Interest/Dividends
Cash Value
Withdrawal & Loan option
Tax Free
Auto Pilot
Terminal illness option
5
The right Life Insurance can be used for many things such as 1. Supplement Retirement 2. Estate Planning 3. Pay for Children’s College Expenses 4. Income Replacement 5. Disability income when you get sick- Living Benefit. 6. Tax Free Assets Etc Can your Current Life Insurance do any of the above listed?
Yes
No
6
Would you like more information
Select one answer
Yes
No
7
Contact Information
Name: Phone #: Email:
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