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Insurance Survey Response Form

The document is a survey form designed to collect information about individuals' demographics, insurance policies, and satisfaction levels. It includes questions regarding personal details such as name, gender, age, marital status, and education, as well as specific inquiries about insurance coverage, payment habits, and overall satisfaction. The survey aims to understand the factors influencing insurance policy decisions and user experiences with insurance applications.

Uploaded by

prakriti sah
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3 views2 pages

Insurance Survey Response Form

The document is a survey form designed to collect information about individuals' demographics, insurance policies, and satisfaction levels. It includes questions regarding personal details such as name, gender, age, marital status, and education, as well as specific inquiries about insurance coverage, payment habits, and overall satisfaction. The survey aims to understand the factors influencing insurance policy decisions and user experiences with insurance applications.

Uploaded by

prakriti sah
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

[Link] (Required to answer Single line text.

Enter your answer

[Link] (Required to answer. Single choice).

 Male
 Female
 Prefer not to say

[Link] (Required to answer. Single choice.)


18-25

26-34

35-44

44-100

[Link] Status (Required to answer. Single choice.)


Married

Unmarried

Divorced

[Link] (Required to answer. Single choice.)


Bachelor's

Master

uneducated

Section 2
[Link] you have insurance Policy?Required to answer. Single choice.
Yes

No

[Link] influenced you to get an insurance Policy?Single choice.


Social Media

Relatives, Friends

Insurance Agent

Government

[Link] type of Insurance do you have?Single choice.


Life Insurance

Health Insurance

Business Insurance

Property Insurance
[Link] is the average term of the policies you have?Single choice.
Up to 5 yrs

Above 20 yrs

[Link] regularly do you pay your premiums?Single choice.


Monthly

Quarterly

Half Year

Yearly

[Link] you prefer web based insurance policy?Single choice.


Yes

No

[Link] the application keep your personal data secure?(Single choice.)


 Yes
 No

[Link] a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with
the following [Link].

 I have easy access to the information on my plan.


 I can easily find doctors in my area.
 I am happy with the plan in insurance policy
 My co-pay is easy for me or a healthcare provider to figure out from my card.

[Link] the web application provide convenient and secure online payment optionSingle choice.
 Yes
 No
 Maybe

[Link] you received any incentives from your insurance company on the insurance premiums?(Single
choice. )
 Yes
 No

[Link] you ever surrendered any Insurance policy?(Single choice.)


 Yes
 No

[Link] you satisfied with your Insurance policy? (Single choice.)


 Yes
 No
 Add new

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