Insurance Study Survey

Hello and thank you for being a part of the Q-insights database.

We’re conducting a 45-60 minute Skype (video chat) interview where you will be compensated $100 as a thank you for your time and opinions.

The sessions will be scheduled beginning November 5th.

If you are interested in participating please complete the questionnaire below.

If you pre-qualify a recruiter will be in touch with you to ask a few additional qualifying questions.

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* 1. What is your gender?

Female

Male

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* 2. What is your age?

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* 3. Do you currently have either home or auto insurance?

Home Only

Auto Only

Both Home and Auto

Neither Home or Auto

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* 4. What is your role when it comes to deciding whether to purchase home or auto insurance for your household and which provider to use? Are you…?

The main decision-maker

Share the decision-making with someone else

Someone else makes all the decisions

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* 5. How long have you been using your current home and auto insurance providers?

	One year or less	2-3 years	4-5 years	Over 5 years	I do not have this type of insurance
Home	Home One year or less	Home 2-3 years	Home 4-5 years	Home Over 5 years	Home I do not have this type of insurance
Auto	Auto One year or less	Auto 2-3 years	Auto 4-5 years	Auto Over 5 years	Auto I do not have this type of insurance

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* 6. When was the last time you filed a claim with either your home or auto insurance provider?

	In the past 12 months	In the past 2-3 years	In the past 4-5 years	Over 5 years	Never	Not Sure
Home	Home In the past 12 months	Home In the past 2-3 years	Home In the past 4-5 years	Home Over 5 years	Home Never	Home Not Sure
Auto	Auto In the past 12 months	Auto In the past 2-3 years	Auto In the past 4-5 years	Auto Over 5 years	Auto Never	Auto Not Sure

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* 7. Which of the following describes how you purchased your last home and / or auto insurance policies?

	Bought through an agent I communicated with in person / by phone / by	Bought online with or without agent involvement	Not sure / don’t recall	I do not have this type of insurance
Home	Home Bought through an agent I communicated with in person / by phone / by	Home Bought online with or without agent involvement	Home Not sure / don’t recall	Home I do not have this type of insurance
Auto	Auto Bought through an agent I communicated with in person / by phone / by	Auto Bought online with or without agent involvement	Auto Not sure / don’t recall	Auto I do not have this type of insurance

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* 8. To check that you have the necessary set up for taking part in this study, can you confirm if you have …

A PC, laptop or other similar device with a working webcam

Working microphone and speakers on the device so you can clearly hear and be heard via a video call

Somewhere you can do the call without too much background noise, so you can be clearly heard and a well-lit room so that we’ll be able to see you clearly on the video

A good and reliable internet connection (e.g., fast broadband) where you will do the video call from

An account that we can contact you on to do a video call for the discussion

None of the above

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* 9. Which, if any, of the following associations / organizations are you a member of?

AARP

Costco

AAA

USAA

None of these

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* 10. Do you currently use any of the following providers for either your home or auto insurance?

The Hartford

Geico

State Farm

Allstate

Progressive

USAA

None of the above

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* 11. How do you describe your ethnic background?

American Indian or Alaska Native

Asian

Black or African American

Hispanic, Latino or Spanish

Native Hawaiian or other Pacific Islander

White

Other (please specify)

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* 12. What is your current marital status?

Single

Married

Living with a partner

Widowed

Separated / Divorced

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* 13. Which best describes your employment status?

Full Time (35 hrs+)

Part Time (under 35 hrs)

Homemaker

Unemployed

Retired

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* 14. As we need to speak with people from all walks of life, please tell me into which category I may place your total annual household income before taxes? Would that be…

Under $35,000

$35,000 to less than $50,000

$50,000 to less than $60,000

$60,000 to less than $90,000

$90,000 to less than $125,000

$125,000 to less than $150,000

$150,000+

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* 15. How comfortable are you in voicing your opinions in a good level of detail? Are you...

Extremely comfortable

Very comfortable

Just comfortable

Not very comfortable

Extremely uncomfortable

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* 16. Please enter your contact information

Name

City/Town

State/Province

Email Address

Phone Number