About this template
This Life Insurance Application Google Form Template is designed for insurance agents, brokers, and agencies looking to streamline their client intake process. Gathering accurate health, financial, and personal details is critical for underwriting and determining appropriate coverage tiers. This template collects everything you need in one organized, secure step—from basic contact information and date of birth to lifestyle metrics, health background, and desired policy plans.
Built for speed and clarity, the form replaces clunky paper documents and unorganized emails with a structured digital workflow. Clients can easily complete the questionnaire from any desktop or mobile device. Once submitted, all information routes directly to your connected spreadsheet or Doc2Form dashboard, allowing your team to review quotes faster, minimize transcription errors, and deliver a seamless onboarding experience.
Key features
- Capture complete personal and contact details in a single submission
- Collect vital health history and biometric indicators for initial review
- Allow clients to specify requested coverage amounts and plan types
- Fully customizable layout that adapts to any brokerage or agency brand
- Instant data collection powered by Google Sheets for fast quote processing
Use cases
Independent insurance agents collecting new policy applications online
Financial planning firms offering comprehensive life and estate cover…
Financial planning firms offering comprehensive life and estate coverage reviews
Insurance brokerages streamlining remote client intake and underwriti…
Insurance brokerages streamlining remote client intake and underwriting preparation
HR teams gathering employee supplemental life insurance enrollment data
What this form collects
- Full Name (Short answer)Enter your first, middle, and last name as it appears on your government-issued ID.
- Date of Birth (Date)Please provide your birth date for age-based underwriting.
- Phone Number (Short answer)Enter the best phone number for us to reach you regarding your quote.
- Email Address (Short answer)We will send your preliminary quotes and follow-up details to this address.
- Residential Address (Paragraph)Provide your current street address, city, state, and ZIP code.
- Life Plan Selection (Multiple choice)Select the type of life insurance policy you are interested in exploring.
- Requested Coverage Amount (Dropdown)Select the desired death benefit amount for your policy.
- Height (Short answer)Enter your height (e.g., 5 ft 10 in).
- Weight (Short answer)Enter your approximate current weight in pounds.
- Health Issues Description (Paragraph)Please list any pre-existing medical conditions, past surgeries, or ongoing treatments. If none, write 'None'.
- Current Total Life Insurance (Short answer)What is the total face amount of any active life insurance policies you currently hold?
- Cancellation Plan Status (Multiple choice)Are you planning to replace or cancel an existing life insurance policy with this new application?
- Work Group Life Status (Multiple choice)Do you currently carry group life insurance through your employer?
- Additional Comments or Questions (Paragraph)Share any extra details or specific questions you have for our agents.
FAQ
How do I customize this life insurance template for my agency?
Once you open the template via Doc2Form, it automatically copies into your Google Drive as a standard Google Form. You can freely add brand colors, rearrange questions, or include specific plan types tailored to your underwriting partners.
Where does the information go when a client submits the form?
All submissions route instantly into a linked Google Sheet stored securely in your Google Drive, giving you immediate access to structured client data for quote generation.
Can I share this form securely with my clients?
Yes. You can share the Google Form link via email, embed it directly into your agency website, or send it via text message for quick completion on mobile devices.
Is this template free to use with Doc2Form?
Yes, you can instantly convert and deploy this template as a Google Form at no cost.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.