Insurance Need Analysis Questionnaire

June 15, 2011

An insurance need analysis questionnaire is a questionnaire that is used to assess the insurance needs of an individual. This analysis is done on the basis of the questions about various details of the individual seeking insurance.

Sample Insurance Need Analysis Questionnaire

Name: First name: _______ Middle name: __________ Surname: _________

Address: Street address __________ City name ________ State name _________

Postal code _________

Residential Contact number: _____________ Mobile number: ________

Email id: _________________

Occupation: __________

Annual income: _______________

Date of birth: ____________

Gender: ____________

1. What is the total valuation of assets that you own?

a) Ten thousand dollars or lesser

b) Fifty thousand dollars or lesser

c) More than fifty thousand dollars

2. What is the total valuation of liabilities that you have?

a) Ten thousand dollars or lesser

b) Fifty thousand dollars or lesser

c) More than fifty thousand dollars

3. Do you have any children?

a) Yes

b) No

4. Please provide the details of the other earning members of your family if any?

___________________

5. How would you like to describe your lifestyle?

a) Very healthy

b) Healthy

c) Somewhat healthy

d) Unhealthy

6. Do you have your property or home insured?

a) Yes

b) No

7. Do you have your vehicle insured?

a) Yes

b) No

7. Do you hold any other kind of insurance policies?

__________________

9. How often do you get a medical checkup done?

a) Once in a week

b) Once in a month

c) Once in a year

10. What type of insurance plan would you like to get for yourself?

___________________

Download Insurance Need Analysis Questionnaire in Word Format

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