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Contact Information
First Name : 
Last Name : 
Email Address : 
 
 
 
* Gender
 
Male
 
Female
 
 
 
* Age
 
Below 20
 
21 to 25
 
26 to 30
 
Above 30
 
 
 
* Occupation
 
Govt. employee
 
Business
 
Student
 
Private employee
 
 
 
* Educational level
 
Under graduate
 
Graduate
 
Post graduate
 
Option 4
 
Other
 
 
 
 
* If you have Insurance of any kind, have you read the Insurance policy?
 
Yes, always
 
Yes, sometimes
 
No
 
 
 
* Which Insurance company are you aware of ?
 
LIC
 
Aviva Life Insurance
 
ICICI prudential
 
Kotak Mahindra
 
Other
 

 
 
 
* Primitive information about Life Insurance
 
Electronic media
 
Print media
 
Social networking
 
Other
 
 
 
 
* Did you receive any insurance awareness programs ?
 
Yes
 
No
 
 
 
* Are you interested to have knowledge about insurance services?
 
Yes
 
No