Age *

Gender * Select Male Female Other

City Type * Select Metro Urban Semi-urban Rural

Marital Status Select Single Married Widowed

Number of Dependents

Occupation *

Industry

Employment Type * Select Salaried Self-employed Business Freelancer Unemployed

Work Environment Select Office Field Factory Mining Construction Remote

Commute Mode Select Bike Car Public Transport None

Chronic Conditions

Family Disease History

Exercise Frequency Select None 1-2 times per week 3-5 times per week Daily

Primary Financial Goal Select Protection Wealth Creation Tax Saving Retirement

Monthly Premium Budget (₹)

Plan Duration Preference Select Short-term (1-5 years) Long-term (10+ years)