Skip to content
Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.
Life Insurance Needs Review
1.
First and Last Name
2.
Date of birth?
3.
What is your height and weight?
4.
Are you a tobacco smoker?
Yes
No
5.
Do you currently have life insurance?
Yes
No
6.
What important to you to protect when it come to life insurance? (can choose multiple)
Income Replacement
How many years of income would your family need if something happened to you?
Would your family be able to maintain their lifestyle?
Debt & Financial Obligations
Do you have outstanding debts (mortgage, student loans, auto loans, credit cards)?
Final Expenses & Legacy Planning
Is leaving a financial legacy important to you?
Do you want to leave funds for children or grandchildren?
Policy Performance (Permanent Policies)
Are you interested in policies that build cash value?
Do you understand how the policy works long-term?
Budget & Affordability
What monthly or annual premium range feels comfortable?
Would you prefer flexibility now or guaranteed coverage long-term?
7.
Which type of insurance is most important to you?
Term Life Insurance
Whole Life Insurance
Final Expense upto 50k
Other (please specify)
8.
Amount of Coverage you are interested in?
15k-50k + Finale Expense
100k-300k
300k+
9.
What's is your city and State?
10.
Phone # & email address ?
Current Progress,
0 of 10 answered