GOASan Diego 4 Christ OutreachVersion 2

Community Insurance Profile Survey

Hello, My name is ______and I’m doing a short survey on Insurance and It’s importance in our community. Would you be willing to take it?

**Surveyor: Complete this section, and read aloud the definition of “insurance” below.**

Community Surveyed:______

City Location:______

Surveyor(s):______

Here is the definition of insurance. Insurance is defined as theprotection or coverage by contract whereby one party takes on the responsibility of guaranteeing the value of another party’s property against loss by an unforeseen circumstance or peril.

1. / Do you agree that the above statement is an accurate definition of insurance? / □ Yes □ No
2. / How important is it to you to have insurance? / □Not important at all
□ Somewhat important
□ Important
□ Very Important
3. / Do you carry any type of insurance? / □ Yes □ No
4. / If yes, which types of insurance do you have? (All that apply) / □ Health
□ Dental
□ Family (Life/ Universal Life)
□ Auto
□ Boat
□ House
□ Loan
□ Renter’s
5. / If no, please explain why.
6. / Do you believe in life after death? / □ Yes □ No
7. / Have you heard of Divine Insurance? (The coverage of your sins, which allows you to gain eternal life through Jesus Christ) / □ Yes □ No

Surveyor: Read these scriptures to the person being surveyed.

- John 3:16 (The Message) - “This is how much God loved the world: He gave his Son, his one and only Son. And this is why: so that no one need be destroyed; by believing in him, anyone can have a whole and lasting life. God didn’t go to all the trouble of sending his Son merely to point an accusing finger, telling the world how bad it was. He came to help, to put the world right again.” - Believe in Jesus & Gain Divine Insurance

-Romans 10:9-10 (NKJV) - “If you confess with your mouth that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved. For with the heart, one believes unto righteousness, and with the mouth confession is made unto salvation.”

Surveyor: Ask the person surveyed if they’d like to receive Divine Insurance. If they say, “Yes”, guide them through the prayer of salvation.

Lord, I thank you for dying on the cross for me. I believe that you died and rose again on the third day so that I might have abundant life with you. I ask you to come into my heart, and be my Lord and Savior. Help to live this life in a way that pleases you. Thank you! Amen

After Survey:

- After salvation, ask them if they have transportation to church. If they do not, inform them of the options provided by their nearest affiliate church.

- Remind them: In Order to continue to keep their policy up to date, they'll need to attend church at least once a week. They will learn more about the benefits of their policy.

- Ask them if you can receive their contact information (including their name) so that you may follow up with them.

- Provide them with an SD4C button, and ask them to wear it when they attend their nearest affiliate church so as to let the church know that they responded to salvation as a result of this outreach survey.

Contact Information:

Name:______

Address/Email Address:______

Phone Number:______

__Salvation/Rededication

__Born Again Believer