An investment survey questionnaire should be filled by current policy holders of insurance policies so that the performance of those insurance policies and the satisfaction levels of the policy holders can be gauged. The results can be collated to suggest the best performing insurance policies.

Sample Insurance Survey Questionnaire:

Name of the policy holder: _______________________

Full Address: ________________________________________________________________

Phone Number: ________________

Date of Birth: ______________ Age: ________ Email id: _____________________________

Q1: Have you taken any insurance policy?

a)   Yes

b)   No

Q2: If the answer to the above question is ‘Yes’, please mention the details of the insurance policy

Term: _____ Maturity year: ____ Premium: _____ Insurance coverage amount: _____________

Q3: Are you happy with your insurance plan?

a)   Yes

b)   No

Q4: Please provide your suggestions on the insurance plan below


Q5: What financial constraints guided you to opt for this plan?

a)   Returns and dividends

b)   Higher return at the end of maturity

c)   Lesser risk

d)   Any others, please mention _________________________________________________

Q6: What do you do with the amount that you receive from the insurance policy?

a)   Reinvest

b)   Spend on financial expenditures

c)   Others please mention _______________________________________

Q7: What are your financial goals?

a)   Income generation

b)   Capital appreciation and income generation

c)   Capital preservation

d)   Other _____________________________

Q8: What are your financial constraints in the short term (1-5 years)?


Q9. What are your financial considerations in the long term (>5 years)?


Q10. Mention your satisfaction level with this insurance policy

a)   Very Dissatisfied

b)   Dissatisfied

c)   Moderately satisfied

d)   Satisfied

e)   Highly satisfied