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Buy Insurance Step 4
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2023-01-17T12:27:23+00:00
Questions
Do you consume Alcohol?
Do not worry, it’s a confidential information!
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First Name
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Last Name
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Date
DD slash MM slash YYYY
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Age
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Gender
Male
Female
Gender X
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Mobile Number
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Email
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Current Height (cm)
(Required)
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Current Weight (kg)
(Required)
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Occupation
(Required)
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Monthly Income (PKR)
(Required)
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Do you intake Tobacco or Nicotine in any form? Yes or no
Yes
No
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Do you intake Tobacco or Nicotine in any form?
0-5 times
5 to 10 times
10 to 20 times
Can't specify
Do you consume Alcohol?
Do not worry, it's a confidential information!
Consume Alcohol Yes or no
Yes
No
Do you consume Alcohol?
Help us identify your consumption pattern
Consume Alcohol Yes or no
Social Drinking
Regular Drinking
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