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Survey questionnaire format for project

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  • 1. Questionnaire-1Dear Sir/Madam Name : Gender : M F 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 assureyou 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 AccomodationPlease do mention the period at current residence Years Months3. Do you have a vehicle? Yes NoIf Yes, Four wheeler Two wheeler Other NoneIs your vehicle Financed Owned Company ProvidedPlease do mention the Vehicle make (model name)4. Your Occupation Salaried Self Employed Retired Housewife Student NRI(Please specify the country you belong)
  • 2. 5. If Salaried, employed with Private Limited Partnership Proprietorship Public Limited Public Sector Government MultinationalMention 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 Others6. If self-employed your firm is Private Limited Partnership ProprietorshipYour 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 AgentPlease specify company nameDesignation7. Are you an account holder in HDFC bank? Yes NoIf yes, Current savings FD DematMention the account numberIf No,Are you an account holder in any other bank? Yes NoIf yes, specify name of the bank and type of account
  • 3. 8. Have you availed loan facilities from any bank? Yes NoIf yes, type of loan Car loan personal loan consumer durable loan loan against shares Housing loan others (please specify)Mention the loan amountName of the bank9. Are you assessed to tax? Yes NoYour gross yearly incomeMonthly expenseDo you have any other source of income? Yes NoIf yes, please specifyAverage income per annum10. Marital status Married SingleIf married,Child 1 ageChild 2 ageChild 3 age11.If you have an existing policy with any insurance company as life assured, assignee,proposer please mention the details belowName of the insurerSum assuredYearly premium amountPolicy start date
  • 4. 12. Do you have any existing insurance cover premium paying and/or paid up policies? Yes NoIf yes, mention the company you investedSum assuredType of policyDate: Signature of the customer:
  • 5. Questionnaire-21. What is your preference on insurance plans? Conventional plan Unit linked plan Not interestedPlease mention your interest on the following Unit linked pension plus Unit linked young star plus Unit linked endowment winner Unit linked endowment plusIf conventional plan Savings assurance plan home loan protection plan Children’s plan Term assurance plan Pension planMention the name of the bank if already invested2. Does your income tax is exempted under section 80C or 80D? Yes No3. Has any proposal for assurance on your life ever been declined, postponed, accepted atextra premium, accepted on special terms, accepted with reduced cover or withdrawn byyourself? Yes No4. Does your occupation or business is hazardous which may render you susceptible toinjury or illness? Yes No5.In 100% working hours, what amount of % do you travel? Mode of Transport6.Have you resided overseas for more than 6 months continuously? Yes NoIf yes,Specify the country and also the duration
  • 6. 7.Do you take part in any hobbies that could be considered dangerous in any way?(Eg. Mountaineering,aviation etc) Yes No8.Are you a “Politically Exposed Person”? Yes No9.Have you ever suffered from or received treatment for any symptoms or medicalconditions in last 6 months? Yes NoIf yes, please specify10. Have any of your Parents,brothers or sisters died or suffered prior to the age of 65? Yes NoIf yes please specify the causeFor office use only:Customer ID :PB :TOC* : H/W/CPrepared By : Date of Preparation :*H-Hot; W-warm; C-cold