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Insurance Form
All information is compulsory unless otherwise stated.
Name
*
Contact Number
*
Are you interested in saving life insurance benefits
*
Yes
No
Are you interested in accident covers and life insurance benefits
*
Yes
No
Average income per month
*
Below ~ 500,000
500,001 ~ 1,000,000
1,000,001 ~ 5,000,000
5,000,001 ~ above
Industry
*
Banking/Insurance/Microfinance
FMCG
Education/Training
Telecommunications
Trading/Distribution/Import/Export
Food and Beverage/Catering
IT/Computer
Manufacturing
Internet Services
Pharmaceutical/Life Sciences
Retail/Wholesale
Real Estate/Property Development
Construction/Building/Architecture
Energy/Water/Oil & Gas/Waste
Advertising/PR/Marketing
Logistics/Transport
Agriculture/Forestry/Fishing
Engineering/Machinery
Consulting/Professional Services
Medical/Hospital
Automotive
Broadcasting/Music/Film
NGO/UN/Non-Profit
Hospitality/Hotels
Interior Design/Decoration
Security/Surveillance
Electronics/Electrical Equipment
Healthcare/Beauty Care
Legal Services
Clothing/Garment/Textile
Jewellery/Gems
Chemicals/Petro-Chemicals
Recruitment/Employment Agency
Others
Age
*
