Group Risk Benefits

Takes about 5 minutes

Member Questionnaire

Understand Your Group Life Benefit

Your employer provides Group Life Cover as part of your employee benefits. This questionnaire helps us understand whether you are familiar with your current benefit and whether the level of cover is aligned with your personal circumstances and financial responsibilities.

Please complete the questions below. Your responses will help us identify areas that may require further discussion with a Benefit Adviser.

Name

Last Name

Contact Number

Employer / Company

Age

Are you aware that you have Group Life Cover through your employer?

Do you know approximately how much Group Life Cover you currently have?

If you know your current cover, please indicate the approximate amount:

Do you understand who would receive your Group Life benefit if you passed away?

Do you currently have people who financially depend on your income?

Approximately how many people depend on your income?

Do you currently have any significant debt that your family may need to settle if you were to pass away?

Which of the following financial obligations do you currently have?
Select all that apply.

Apart from your employer’s Group Life Cover, do you have additional life insurance?

If you have additional life cover, approximately how much cover do you have?

If you were no longer able to provide for your family, how long could your current savings and investments support them?

How confident are you that your current life cover would be sufficient to protect your family financially?

Would you like to understand how much life cover you may need based on your current financial responsibilities?

Yes No Maybe / I’d like more information

Which concern about retirement is most important to you?

Would you like a Benefit Adviser to review your current Group Life Benefit with you?

Is there anything about your Group Life Benefit or financial protection that you would like us to explain?

Would you like a Benefit Adviser to review your current Group Life Benefit with you?

Preferred contact time

POPIA

I consent to 4D Employee Benefits using my information to respond to this enquiry