A general insurance questionnaire is a useful document to gauge the consumer attitude and acceptance of the general insurance policies. The questionnaire can be analysed for developing the performance of such policies.

Sample General Insurance Questionnaire:

First Name: _______________________ Last Name: _____________

Full Address: _____________________________

Phone Number: ________________________

Email address: _________________________

Gender: ______

Date of Birth: ___/___/___

Q1. Please mention your gross income

$ ______________

Q2: Please mention your type of occupation

a)   Private employee

b)   Government employee

c)   Own business

d)   Others, please mention ___________________________________

Q3: What is your duration of work experience?

Experience in months: __________

Q4. Which of the following general insurance policies have you taken?

a)   Home insurance

b)   Car insurance

c)   Fire insurance

d)   Health insurance

e)   Any others, please mention ________________________________

Q5: Have you undergone any medical surgeries or treatments earlier?

a)   Yes

b)   No

Q6. If the answer to the above question is ‘yes’, please provide the details of the medical history

Illness: ______________ Treatment: _________________________ Date: ___________

Illness: ______________ Treatment: _________________________ Date: ___________

Q7. Please provide the current status of these illnesses

Illness: ______________ Status: _____________________________________________

Illness: ______________ Status: _____________________________________________

Q8: For which of the following do you want to take a general insurance?

a)   Two-wheeler

b)   Four-wheeler

c)   Home

d)   Health

e)   Travel

f)    Accident Cover

g)   None

Q9. If the answer to the above question is ‘none’, please provide a reason for not opting for these general insurance policies


Q10. Have you ever claimed reimbursement for any insurance coverage for loss incurred?

a)   Yes

b)   No

Q11. If the answer to the above question is ‘yes’, please provide your opinion on the kind of response received from the insurer?