Insurance Questionnaire Example


Insurance questionnaire example is basically a sample questionnaire that contains relevant insurance questions and needs to be filled by insurance owners. This type of questionnaire is used by insurance companies and the industry to derive feedback from insurance owners regarding various insurance products and customer experience etc.

Sample Insurance Questionnaire Example:

Name: ____________________________

Address:___________________________________

Gender: _____________________

Age: ___________________

Email:______________________________

Policy Number: _______________________

Type of Insurance: _____________________

Q1. What is the amount of premium you are currently paying on your policy per month?

  • Less than $500
  • $500 – $1,000
  • $1,001 – $2,000
  • $2,001 – $4,000
  • More than $4,000

Q2. Have you ever bought an insurance policy from any of the following companies? If yes then please mention, what type of policy did you buy?

  • American International Group (AIG)
  • Allianz Worldwide
  • Prudential Financial
  • MetLife
  • Allstate Insurance
  • State Farm Insurance
  • Fidelity Insurance
  • Hartford Insurance
  • New York Life

Q3.  Do you currently own a life insurance policy?

  • Yes
  • No

Q4. If you own a life insurance policy then which of the following policy is it?

  • Term Insurance
  • Permanent life insurance
  • Whole life coverage
  • Universal life coverage
  • Limited pay life insurance
  • Endowments
  • Accidental death
  • Others

Q5. Have you ever invested in an annuity?

  • Yes
  • No

Q6. Have you ever made a claim on your existing insurance policy? If yes, then please mention the type and amount of claim.

  • Yes
  • No
  • Type of claim: ___________________________
  • Amount of claim: $ ___________

Q7. How much is your current insurance cover worth?

  • Less than $10,000
  • $10,000 – $25,000
  • $25,000 – $50,000
  • More than $50,000

Category: Insurance Questionnaire

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