Understanding Your Insurance Needs
PROTECTION : Unexpected events may strike anyone anytime (e.g. accident, disability, loss of job)
 1) If this happens, will you and your family be able to maintain the current standard of living?
           Yes                       No
 2) If this happens, do you have ready funds sufficient to cover household expenses?
           Yes                       No
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 HEALTH / MEDICAL - Health and medical are of great significance needs anytime.
 3) Medical costs are rising between 12% - 15% every year. Would you want a plan that can protect you against the rising medical costs?
           Yes                        No
 4)    In event of illness or accident, do you have sufficient funds to cover the medical or hospitalization expenses?
           Yes                        No
 ____________________________________________________________________________________________________
 SAVINGS / INVESTMENT - Our savings / returns from our investments enable us to maintain our lifestyle.
 5) What do you want to achieve from your investment?
            To have returns on a regular basis
            To have returns on a regular basis and have capital gains
            To have capital gains
 6) What is your investment time horizon?
           1  5 years                6  10 years             11  20 years             > 20 years
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 EDUCATION - One of the best gifts parents can give their children is the gift of education for a better future.
 7) Where would you prefer to send your children for their higher education?
            Local University                  Overseas College/University           Private University (twinning program)
 ____________________________________________________________________________________________________
 RETIREMENT - Retirement is your time to enjoy the fruits of your labour after your active working years.
 8)    What do you expect upon your retirement?
           Maintain your current lifestyle                           Enjoy a luxury lifestyle
 ____________________________________________________________________________________________________
 9) Currently, do you have any life insurance or medical plan?
            Yes                      No
      If yes, please specify
 10) What kind of insurance benefits are important to you? (You may choose more than one)
            Protection               Savings / Investment         Retirement          Health           Education
 11) How much would you be willing to set aside every month for the above insurance coverage(s)?
            RM 150                   RM 200                       RM 300              RM 400           RM 500
 Customer Information
 Name:                                                    Occupation: 
 Address: 
 Email:                                                   Annual Income:
 Mobile number: ..                                             ( ) Below RM 20,000       (     ) RM 20,000  RM 40,000
                                                                            ( ) RM 40,000  RM 80,000 (     ) RM 80,000  RM 100,000
 Age:( ) < 20 ( ) 20-29 ( ) 30-39 ( ) 40-49 ( ) >50                         ( ) Above RM 100,000
 Marital status: (    ) Single   (        ) Married                         No. of children: . Age range of children: 
 Who else can benefit from this?
 (Note: Please ensure that the individuals named below have consented to the release of their name and contact details to AIA Bhd.)
                     Name                             Telephone No.                             Name                          Telephone No.
Declaration: I understand and agree that any personal information collected or held by AIA Bhd. (AIA) (whether contained in this application or
otherwise obtained) may be held, used and disclosed by AIA to individuals/organization related to and associated with AIA or any selected third party
(within or outside of Malaysia, including reinsurance and claims investigation companies and industry/federations) for the purpose of processing this
survey and providing service to AIA financial products and to communicate with me for such purposes. I understand that I have a right to obtain access
to and to request correction of any personal information held by AIA concerning me/us. Such request can be made to any AIA Customer Service Centre.
 __________________
 Customers Signature
 Name: