Part One
1. Gender
A: Male	B: Female
2. Age
3. Nationality
4. Political Status
5. Status of Household
6. Monthly Income
7. Status of Job
8. Education Level
Part Two
1. How much do you know about LTCI policies
A: Very Well	B: Well	C: Not too Much	D: Not at all
2. Are you disabled
A: Yes	B: No
3. If Yes, What is your degree of disability
A: Partial	B: Severe	C: Completed
4. If Yes to Question2, Where are you in servicing
A: Home	B: Local Community	C: Professional Institution	D: Hospital
5. How many Kids do you have:
6. Do you satisfy with the performance of LTCI
A: Satisfied	B: Neutral	C: Dissatisfied
7. Any Comments to the LTCI