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1. Name :
2. Age :
3. Gender :
a) Male □ b) Female □ c) Others □
4. Educational qualification:
a) Illiterate □
b) Higher secondary □
c) Graduate □
d) Post graduate
5. Marital status :
a) Married □
b) Single □
6. Occupation:
a) Business □ d) Housewife □
b) Service □ e) Student □
c) Agriculture □ f) Other □
7. Type of Organization:
a) Private □ b) Government □
8. House ownership :
a) Own □ b) Rented □
9. What is the source of your regular monthly income? (You can choose more than one
answer.
a) Employment (employment income)
b) Business activities
c) Retirement pension, other pensions, allowances, social security benefits
d) Income from property tenure (real estate lease, etc
e) Other
a) Two □ c) Three □
a) Yes □ b)No □
a) Yes □ b) No □
18. Where do you invest your savings? (You can choose more than one answer.)
b) Shares/Debentures □ f) Gold/Silver □
b) Medium (1-5yrs) □
22. What were the reasons for not availing any form of insurance?
a) Too expensive, can't afford it □
b) Just don't bother, no real reasons □
c) No need for it □
d) I don't have much, nothing valuable □
e) I am in process of doing it □
f) No insurance men coming to door now □
g) Have to have bank account □
h) If others, (please specify) ______________
23. Did you take insurance policy from the same bank in which you hold bank account?
a) Yes □ b) No □
25. Express your level agreement with respect to the following factors that motivates you take
insurance policy from bank
26. Which type of insurance policy you have taken from bank?
a) Life □
b) Non life □
c) Both □
28. Which installment mode you preferred for making premium payment?
a) Yearly □ c) Half yearly □
b) Quarterly □ d) Monthly □
30. Do you have a savings and investment target amount you aim for each year?
a) Yes □ b) No □
28. Which of the following best describes financial decision-making in your household?
a) Yes □ b) No. □
30. Have you thought about how you are going to manage financially when you come to retire?
31. Thinking about your finances: when you come to retire, do you expect to have the same
standard of living as you have now?
a) I think it will be the same as I have now □
b) I think it will be better than now □
c) I think it will be worse than now □
d) Don’t know □
32. What do you think that the Government, Local bodies, Banks, NGOs and others might need
to do to further achieve financial inclusion?