An insurance risk survey questionnaire helps in identifying the current insurance and liability systems established and the risk concerned with these systems. This type of survey questionnaire also helps in identifying the existing insurance plans and offers an insight into how fruitful or beneficial these plans are for the insured. It helps in identifying various risks and helps an organization, individual, or insurance company to provide plans based on particular risks.

Insurance Risk Survey Questionnaire Sample

Name of the individual: ________________________________

Age: ______ Sex: _______  Occupation: ______________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Email: _________________________

Insurance plan: (if any) ___________________________________________

Insurance Policy Number: (if any) ___________________________________________

Q1. Are you aware of the various insurance plans available?

a)   Yes

b)   No

Q2. Why do you need insurance?


Q3. What are the probable risks that you face and how can insurance mitigate the level of risk?


Q4. Which of the following insurance plans do you have?

a)   Health insurance

b)   Life insurance

c)   Home insurance

d)   Auto insurance

e)   Travel insurance

f)    Disability insurance

g)   Business insurance

Q5. Which of the following risk factors you might encounter the most?

a)   Definite loss (fire, accidents, occupational hazards)

b)   Accidental loss (business risks, lottery etc)

c)   Large loss (business losses)

d)   Calculable loss

e)   Natural loss (losses due to natural calamities)

Q6. Have you ever made a claim on your existing insurance policy?

a)   Yes

b)   No

c)   Don’t remember

Q7. Which risks according to you are at the top of your list?

a)   Health problems

b)   Accidents

c)   Natural calamities

d)   Accidents due to fault of others

e)   Damages caused by others

f)    Business and economical problems