Sample Survery Questionnaire by aniltheblogger

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Questionnaire-1 Dear Sir/Madam Name Gender Date of birth No of dependants Address : : : : :



I 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 3. Do you have a vehicle? Yes No


If Yes, Four wheeler

Two wheeler



Is your vehicle Financed Owned Company Provided Please do mention the Vehicle make(model name) 4. Your Ocuupation Salaried Student Self Employed Retired Housewife 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 centres/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 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 Housing loan others(please specify) Mention the loan amount Name of the bank

loan against shares

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 If married, Child 1 Child 2 Child 3 Single

age age 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


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 Term assurance plan Children’s plan

home loan protection 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

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