Insurance leads need different details by product: a health quote needs who is covered and their ages, a term quote needs age and income, a motor quote needs the vehicle and expiry date, and travel needs destination and dates. This form asks which cover the person wants, then shows only those questions, so you can quote on the first call.
Why this template
21 pre-built fields, edit, remove, or add more in the form builder.
Your Name
Phone Number
City
Which Insurance Are You Looking For?
Health insurance · Term life insurance · Motor insurance · Travel insurance
Who Needs the Cover?
Myself · Myself and spouse · Family with children · My parents
Age of the Eldest Member
Cover Amount
5 lakh · 10 lakh · 25 lakh · 50 lakh or more · +1 more
Do you already have a health policy?
Your Age
Yearly Income
Under 5 lakh · 5 to 10 lakh · 10 to 25 lakh · 25 to 50 lakh · +1 more
Cover You Want
50 lakh · 1 crore · 2 crore · 5 crore or more · +1 more
Do you use tobacco?
Vehicle Type
Car · Two-wheeler · Commercial vehicle
Vehicle Make and Model
Current Policy Expiry Date
Any claim in the last year?
Travel Destination
Travel Start Date
Number of Travellers
Is any traveller above 60 years?
Best Time to Call
Morning (9 to 12) · Afternoon (12 to 4) · Evening (4 to 8) · Any time
Free · No credit card · Customize every field
Click "Use this template free", the form builder opens with all fields pre-loaded.
Edit labels, add your branding, reorder fields, or add conditional logic. Hit Publish.
Share via WhatsApp link, embed on your website, or print a QR code. Responses land in your dashboard.
In practice
An advisor shares this link in a WhatsApp broadcast before the financial year ends. One person picks health and answers who needs cover, the eldest age and cover amount. Another picks motor and gives the vehicle and expiry date. Each lead shows up with what is needed to quote.
Not a fit if
No. It captures leads only. You quote and complete the policy through your insurer or platform.
Yes. Add an option such as home or fire insurance and use conditional logic to show its follow-up questions.
Do not ask for Aadhaar, card numbers, OTPs or passwords in a form. FormBharat blocks those fields. Collect identity documents through your insurer's own process.