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Customer Exit Survey
Member Number
Full Name
Date
Have you:
Transferred to another fund
Terminated without transferring
If you transferred to another fund, what was the main reason?
Price
Customer service
Hospital benefits
Ancillary benefits
Convenience as moved to mainland
Corporate plan
Advertised product
Other
Which fund did you transfer to?
What product did you transfer to?:
If you did not transfer to another fund, what was the main reason for cancelling your policy?
Can't afford
Not required
Dissatisfied with claim
Customer service
DVA Gold Card
Other
If you cancelled for financial reasons, can we contact you to discuss more affordable options?
Yes
No
If yes, what is the best time to contact you?
Phone Number
In follow up to the above questions, can you briefly expand on your reason for transferring/cancelling?
What could we have done better in order to have kept your membership?
Submit