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1 2 3 4 5   PERSONAL INFORMATION   Name Age   Email Mobile No   Family SINGLE NO CHILDREN YOUNG CHILDREN TEEN CHILDREN CHILDREN 18+ Occupation EMPLOYED SELF EMPLOYED BUSINESS OWNER RETIRED   Income(Lac) 3-5 5-10 10-25 25-30 50-100 Health GOOD HEART DIABETIC OVER WEIGHT   LIFE INSURANCE INFROMATION SA, Risk(Lac) 10-20 20-50 50-100 100+ Fund Value(Lac) 5 10 25 50 100   Duration 5 10 20 30 60 Premium 25,000 50,000 100,000 250,000 500,000   PremiumPT 5 10 20 30 60 Riders   Risk appetite Low Medium High   HEALTH INSURANCE INFROMATION   Sum Insured (Lac) 1 3 5 10 Family Floater Yes No   MUTUAL FUNDS INFORMATION   Amount(Lac) 1 5 10 50 100 Duration < 1 1 3 5   Risk appetite Low Medium High   OTHER PRODUCTS   Catagory Equity Commodities Real Estate Other Comments

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