- First name (mandatory field)
- Last name
- Email address (mandatory field)
- Date of birth (drop down menu for each of date, month and year)
- Gender: Male/female
- City of residence (drop down menu)
- Country of residence (drop down menu)
- Occupation (drop down menu)
- of family members at residence (drop down menu)
- of kids under 18 at your residence (drop down menu)
- Total salary of family before tax (drop down menu with ranges)
Option to change password and reenter new password (but only when logged in)