About this template
The Life Insurance Application Questionnaire is a critical tool for insurance agents and financial advisors to streamline the client intake process. This template is designed to capture essential applicant data, including personal demographics, employment status, financial goals, and comprehensive health history, ensuring you have the necessary information to perform accurate risk assessments and provide tailored policy recommendations.
By moving your intake process to a digital format, you eliminate the need for manual data entry and paper-based records. This template helps you gather consistent, structured data from every prospect, allowing for faster underwriting and a more professional client experience. Whether you are an independent broker or part of a larger firm, this form provides a clean, mobile-responsive interface that makes it easy for clients to provide sensitive information at their convenience.
Key features
- Standardized fields for medical history and lifestyle habits.
- Clear sections for beneficiary and financial information.
- Mobile-friendly design for easy client completion.
- Automated data collection directly into your Google Sheets.
- Easily customizable to match your agency branding.
Use cases
- New client onboarding for life insurance policies.
- Preliminary risk assessment for life insurance underwriting.
- Annual policy review and beneficiary updates.
- Gathering information for financial planning consultations.
What this form collects
- Full Name (Short answer)Please enter your full legal name.
- Date of Birth (Date)Format: MM/DD/YYYY
- Gender (Multiple choice)Required for underwriting purposes.
- Height and Weight (Short answer)Please provide your current height and weight.
- Do you currently use tobacco products? (Multiple choice)This includes cigarettes, cigars, vaping, or chewing tobacco.
- Medical History (Paragraph)Please list any chronic conditions or major surgeries.
- Current Medications (Paragraph)List all medications you are currently taking.
- Desired Death Benefit Amount (Short answer)The amount of coverage you are seeking.
- Estimated Annual Income (Short answer)Your current gross annual income.
- Primary Beneficiary Name (Short answer)Full name of the person who will receive the benefit.
FAQ
Is this template secure for sensitive medical information?
Google Forms provides robust encryption for data in transit and at rest. Ensure your Google account settings are configured for maximum security when handling sensitive client data.
Can I customize the fields in this template?
Yes, once you copy this template to your Google Drive, you can add, remove, or reorder any questions to suit your specific agency requirements.
How do I receive notifications when a client submits the form?
In your Google Form settings, you can enable email notifications under the 'Responses' tab to be alerted immediately whenever a new application is submitted.
Can I export the collected data to other software?
Yes, all responses are automatically saved to a Google Sheet. From there, you can export the data as a CSV or integrate it with your CRM using tools like Zapier.
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.