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* 1. When you think about life insurance, what comes to mind? You can choose more than one. 

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* 2. If you took out a life insurance policy, how much would you be willing to spend in a week for premiums?

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* 3. If you took out life insurance, what would you be taking it out for? You can choose more than one. 

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* 4. Where have you heard about BSP Life insurance? You can choose more than one.

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* 5. Are you thinking of taking up life insurance and are willing to receive marketing material from BSP Life in the future?

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* 6. Name: 

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* 7. Email:

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* 8. Mobile Number:

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* 9. Age:

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