Demographic Information

Full Name

[YOUR NAME]

Age

[YOUR AGE]

Gender

• Male

• Female

• Other

Employment Status

• Employed

• Unemployed

• Self-employed

• Student

• Other (pls. specify): _______________

Annual Income

• Less than $25,000

• $25,000 - $50,000

• $50,001 - $75,000

• $75,001 - $100,000

• More than $100,000

Credit Usage and History

Number of credit cards

• None

• 1-2

• 3-5

• More than 5

Applied for loans in the past 12 months?

• Yes

• No

Type(s) of loan applied for

• Personal Loan

• Mortgage

• Auto Loan

• Student Loan

• Other (pls. specify): _______________

Credit Management Practices

Frequency of checking credit score

• Monthly

• Quarterly

• Annually

• Rarely

• Never

Late on credit payments or loan installments?

• Yes

• No

Frequency and reasons for late payments

[Occasionally missed payments due to unexpected medical expenses.]

Financial Goals and Challenges

Primary financial goals in the next 12 months

[Save for a down payment on a house.]

Challenges in managing credit effectively