J. Clifton Avery Insurance Agency
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Lifestyle Risk Assessment Form
   
   
 
 

LIFESTYLE PROTECTION RISK ASSESSMENT

Is a Personal Risk Management Assessment part of your Financial Plan? What are your risk factors? What protection do you need? The answers to the following questions can help determine what type of Lifestyle Protection Plan is best suited to your needs.


Your Name:
Phone:
Email:
  Yes No Unsure
PERSONAL RESIDENCE      
If your home was damaged or destroyed, is it important that it be insured for the true cost of repairs?
Have you had a recent evaluation of your home's true replacement cost?
Would you like more information on flood insurance?
Do you own a secondary residence(s)?
Are you interested in obtaining various deductible options and estimated savings for these options?
PERSONAL SECURITY      
Do you have children that currently live at home?
Do you have children that are away at school?
If yes, do you have a plan in place to protect your children if something were to happen to you or your spouse?
If you become unable to work due to illness or injury do you have a plan in place to protect your lifestyle?
Have you considered Long-Term Care Insurance as
part of your overall financial plan?
Do you currently have an estate plan?
If yes, do you know how your estate plan affects your
insurance coverage?
Does your current personal liability policy include coverage for identity theft?
Would you like more information on identity theft and the cost to cover yourself from an identity theft incident?
Do your or your family members travel outside of
the United States?
PERSONAL LIABILITY      
Do you employ domestic staff such as a
housekeeper or nanny?
Do you serve as a director, officer or member of the board for a public, private and/or non-profit organization?
Do you conduct business in your home?
Do you update your liability limits regularly to reflect your personal net worth taking into account your personal exposures?
VALUABLE POSSESSIONS      
Do you collect jewelry, fine art, silver or other
fine possessions?
Do you have dedicated insurance coverage (a valuable articles policy) for the items you collect?
Do you maintain a thorough inventory of your
valuable possessions?
Do you own and/or collect antique or vintage
automobiles or boats?

   


 
 
Give us a call,
We've got you covered!
(800)759-7579
 
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Portsmouth Insurance Office

7 Islington Street  |  Unit 102
Portsmouth, NH 03801

Tel 603.766.3733  |  Fax 603.766.3732


Wolfeboro Insurance Office

PO Box 1510  |  21 South Main Street
Wolfeboro, NH 03894

Tel 603.569.2515 
Fax 603.569.6538



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