Questionnaire-1

Dear Sir/Madam

I
Name :
Gender : M F
Date of birth :
No of dependants :
Address :

am the student of [COLLEGE NAME], Department of Management studies, [PLACE]

and presently doing a project on Analysis of Marketing Strategies on [RESPECTIVE
NAME]. I request you to kindly fill the questionnaire below and assure you that the data
generated shall be kept confidential.

1. Educational Qualification

10th or below 10+2 or below Graduate

Post Graduate and above Others(please specify)

2. Your residence is

Owned Rented Company Provided

Ancestral/Family PG Accomodation
Please do mention the period at current residence Years Months

3. Do you have a vehicle?

Yes No

If Yes,
Four wheeler Two wheeler Other None

Is your vehicle
Financed Owned Company Provided
Please do mention the Vehicle make (model name)

4. Your Occupation

Salaried Self Employed Retired Housewife

Student NRI(Please specify the country you belong)
5. If Salaried, employed with

Private Limited Partnership Proprietorship Public Limited

Public Sector Government Multinational
Mention the type of industry your employed,

Advertising/market research Textile Banking Transport

Construction/real estate Travel/Tourism Entertainment/Media
Telecom Consumer goods Insurance Export/Import
Internet services NBFC Call centers/BPO/ITES
Hotel/Restaurant Finance Information Technology
Pharmaceuticals Others

6. If self-employed your firm is

Private Limited Partnership Proprietorship

Your nature of work in the firm,

Broker Journal Landlord Software Professional
Chartered Accounted Films/Entertainment professional
Consultant Lawyer Manufacturer Doctor
Engineer Trade/Distributor Financier Retailers/Grocers
Real Estate Agent
Please specify company name
Designation

7. Are you an account holder in HDFC bank?

Yes No

If yes,
Current savings FD Demat
Mention the account number

If No,
Are you an account holder in any other bank?
Yes No
If yes, specify name of the bank and type of account
8. Have you availed loan facilities from any bank?

Yes No

If yes, type of loan

Car loan personal loan consumer durable loan loan against shares
Housing loan others (please specify)
Mention the loan amount
Name of the bank

9. Are you assessed to tax?

Yes No

Your gross yearly income

Monthly expense

Do you have any other source of income?

Yes No

If yes, please specify

Average income per annum

10. Marital status

Married Single

If married,
Child 1 age
Child 2 age
Child 3 age

11.If you have an existing policy with any insurance company as life assured, assignee,
proposer please mention the details below

Name of the insurer

Sum assured
Yearly premium amount
Policy start date
12. Do you have any existing insurance cover premium paying and/or paid up policies?

Yes No
If yes, mention the company you invested
Sum assured
Type of policy

Date: Signature of the customer:

 Questionnaire-2

1. What is your preference on insurance plans?

Conventional plan Unit linked plan Not interested

Please mention your interest on the following

Unit linked pension plus
Unit linked young star plus
Unit linked endowment winner
Unit linked endowment plus

If conventional plan
Savings assurance plan home loan protection plan Childrens plan
Term assurance plan Pension plan

Mention the name of the bank if already invested

2. Does your income tax is exempted under section 80C or 80D?

Yes No

3. Has any proposal for assurance on your life ever been declined, postponed, accepted at
extra premium, accepted on special terms, accepted with reduced cover or withdrawn by
yourself?

Yes No

4. Does your occupation or business is hazardous which may render you susceptible to
injury or illness?

Yes No

5.In 100% working hours, what amount of % do you travel?

Mode of Transport

6.Have you resided overseas for more than 6 months continuously?

Yes No

If yes,
Specify the country and also the duration
7.Do you take part in any hobbies that could be considered dangerous in any way?
(Eg. Mountaineering,aviation etc)

Yes No

8.Are you a Politically Exposed Person?

Yes No

9.Have you ever suffered from or received treatment for any symptoms or medical
conditions in last 6 months?

Yes No

If yes, please specify

10. Have any of your Parents,brothers or sisters died or suffered prior to the age of 65?

Yes No
If yes please specify the cause

For office use only:

Customer ID :
PB :
TOC* : H/W/C

Prepared By : Date of Preparation :

*H-Hot; W-warm; C-cold