SIDDANNA M BALAPGOL

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

2. 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

3. 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

4. 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:

5. 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 Children’s 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

6. 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

7. 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