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Life Insurance Survey
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1.
Do you currently have life insurance?
(Required.)
Yes
No
I don’t know
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2.
How much do you expect it will cost to handle your final expenses?
(Required.)
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3.
What is the name of your beneficiary?
(Required.)
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4.
What is your budget?
(Required.)
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5.
What is your date of birth?
(Required.)
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6.
Are you employed?
(Required.)
Yes
No
7.
If so, what is your occupation?
8.
What is your favorite hobby?
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9.
What is your full name?
(Required.)
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10.
What is your address?
(Required.)
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11.
What is your phone number?
(Required.)
12.
What is your relationship to your beneficiary?