Full Name *

Phone *

Date of birth *

Email *

Facebook Account

I have read and agree to the Terms and Conditions and Privacy Policy, and I consent to the collection and processing of my personal information as described therein.

Do you currently have children or dependents? *

No dependents

1 dependent

2 dependents

3 or more dependents

What is the age range of your youngest dependent? *

No dependents

13–18 years old

6–12 years old

0–5 years old

If something happened to you, mga ilang years pa kaya mangangailangan ng financial support ang dependents/family mo? *

Less than 10 years

10–15 years

15–20 years

More than 20 years

Do you currently have loans, mortgages, or other financial obligations that would still affect your family? *

Less than ₱500,000

₱500,000–₱1,000,000

More than ₱1,000,000

If your income suddenly stopped tomorrow, ilang months kaya makakaya ng family mo na i-maintain ang kanilang current lifestyle? *

More than 1 year

6–12 months

3–6 months

Less than 3 months

Do you currently have life insurance or financial protection in place? *

Yes, and I believe it's sufficient

Yes, but I'm not sure it's enough

No, I don't have any protection yet

Imagine a major illness requiring approximately ₱1,000,000 in treatment costs.

How would you most likely pay for it? *

Personal insurance coverage

Company insurance / HMO

Personal savings

PhilHealth / government benefits

Loans or borrowing

Support from family and friends

Would you like to know if your current protection is enough? *

Maybe

Yes

What monthly amount would feel comfortable for protecting your family's future? *

₱5,000+

₱3,000–₱4,000

₱2,000–₱3,000

What made you take this Insurance Checkup today? *

I want to be insured today

I’m comparing plans right now

I’m just learning how insurance works

When you find a plan that suits your needs, how soon would you like to have it in place? *

As soon as I can

Within the next 3 months

Within the year

Just searching for now

What is your approximate monthly household income? *

Below ₱20,000

₱20,000–₱50,000

₱50,000–₱100,000

₱100,000–₱200,000

₱200,000 Above

Gap Score