A Prudential life insurance questionnaire is a document drafted by the Prudential Life Insurance. Prudential Life Insurance is a company selling insurance policies, so whenever an individual approaches the company to buy insurance policies, the company provides them with a form which can be available on the company website or sent to the individual through e-mail or may be handed out manually. The questionnaire helps to gather few information about the individual like past health problems, lifestyle and also what kind of return the customer expects from the policy. The questionnaire also helps the company to assess the risk hazards of granting insurance policy to the individual.

Sample Prudential Life Insurance Questionnaire:

Name: _____________________

Date of Birth: ____/____/____

Street Address: ____________ City: ___________, State: ___________, PIN: _____________

Mobile number: _______________

Working Phone Number: ______________

Email Address: _____________________

Q1. What is the monthly salary that you receive?

a)   More than 10000

b)   More than 20000

c)   More than 50000

Q2. What percentage of your salary do you convert into investments?

a)   10 percent or less

b)   20 percent or less

c)   30 percent or less

d)   More than 30 percent

Q3. What kind of investments do you usually make?

a)   Fixed deposit

b)   Mutual funds

c)   Term insurance

d)   Shares

e)   Government bonds

f)    Others, please specify ____________

Q4. Do you have any other life insurance policy?

a)   Yes

b)   No

Q5. If the answer to the above question is yes, what kind of life insurance do you have?


Q6. What is your main motive to apply for an insurance policy?