Home Policy Protection Checklist, complete our renewal questionnaire home policy

Home Policy Protection Checklist

61% of claims Denied by insurance companies result from unreported changes and unreported property or vehicles.

Five minutes of your time to complete this home policy protection checklist questionnaire will help eliminate claims problems.

There are no wrong answers and your response will enable us to discuss coverage concerns and provide recommendations for your home insurance renewal.

Complete and submit the form below and a personal lines insurance agent will follow up with you to discuss your home insurance policy renewal.

We thank you for your business and look forward to hearing from you soon!

You can also print the form and mail or fax back to our office.

Home Policy Protection Checklist

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Daytime Phone*
Daytime Phone*

Have you remodeled your home, added any additions, built any outbuilding or garages, or made any improvements to finish your basement?*
Have you remodeled your home, added any additions, built any outbuilding or garages, or made any improvements to finish your basement?*

	Yes
	No

Have you refinanced or changed your mortgage company this year?*
Have you refinanced or changed your mortgage company this year?*

	Yes
	No

If yes, name, address, and loan number?

If yes, is the insurance escrowed?

	Yes
	No

I would like to SAVE 10%-23% on my property insurance by INCREASING my deductible to $1,000 or $2,500*
I would like to SAVE 10%-23% on my property insurance by INCREASING my deductible to $1,000 or $2,500*

	Yes
	No

Have you acquired any valuable guns, jewelry or collectable items?*
Have you acquired any valuable guns, jewelry or collectable items?*

	Yes
	No

Do you want your home paid for in the event of a death? (You're 30 times more likely to lose a home because of a death of a spouse.)*
Do you want your home paid for in the event of a death? (You're 30 times more likely to lose a home because of a death of a spouse.)*

	Yes
	No
	Would like more info

Would it cost more to rebuild your home, than the amount you have it insured for?*
Would it cost more to rebuild your home, than the amount you have it insured for?*

	Yes
	No
	Not Sure

Do you own a second home such as a weekend or summer property?*
Do you own a second home such as a weekend or summer property?*

	Yes
	No

Have you added a new security or fire alarm system to your home?*
Have you added a new security or fire alarm system to your home?*

	Yes
	No

Do you own any ATVs, boats, snowmobiles, or other recreational vehicles?*
Do you own any ATVs, boats, snowmobiles, or other recreational vehicles?*

	Yes
	No

Have you updated the wiring, heating, roof or plumbing in your home?*
Have you updated the wiring, heating, roof or plumbing in your home?*

	Yes
	No

Do you have a trampoline?*
Do you have a trampoline?*

	Yes
	No

Do you have any pets?*
Do you have any pets?*

	Yes
	No

If yes, what kind and how many?

Would you be interested in obtaining information on a $1,000,000 umbrella liability insurance policy that would protect you in the event of a catastrophic accident for as little as $3.00 a week?*
Would you be interested in obtaining information on a $1,000,000 umbrella liability insurance policy that would protect you in the event of a catastrophic accident for as little as $3.00 a week?*

	Yes
	No

Are you running any business out of your home or give private lessons on your premises?*
Are you running any business out of your home or give private lessons on your premises?*

	Yes
	No

If yes, description of business

Are you babysitting two or more children in your home on a regular basis?*
Are you babysitting two or more children in your home on a regular basis?*

	Yes
	No

Do you have any rental or investment properties?*
Do you have any rental or investment properties?*

	Yes
	No

Would you like to have Flood coverage? *
Would you like to have Flood coverage? *

	Yes
	No
	Already Have Coverage

Would you like to have Earthquake coverage?*
Would you like to have Earthquake coverage?*

	Yes
	No
	Already Have Coverage

Would you like to have backup of sewer or drain coverage?*
Would you like to have backup of sewer or drain coverage?*

	Yes
	No
	Already Have Coverage

Would you like to have HE-7 home owners enhancement coverage?*
Would you like to have HE-7 home owners enhancement coverage?*

	Yes
	No
	Already Have Coverage

Do you have any questions about your renewal?

List any additional information that may assist us

Please enter the word that you see below.

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