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Personal Insurance Renewal Questionnaire
Personal Insurance Renewal Questionnaire
Full Name
*
Today's Date
MM slash DD slash YYYY
Phone
*
Email
*
Occupation
After Reviewing the attached Summary of Insurance, are there any changes that need to be made to your homeowner, auto or umbrella policies? *
Please choose one...
Yes
No
Please describe:
*
Is your property held in a trust?
*
Please choose one...
Yes
No
Name of trust
*
Improvements & Upgrades
Have you made any recent improvements or upgrades to your home? *
Choose one...
Yes
No
Location
Improvement
Year done
Comments
Valuable Possessions
Do you own any of the following items that do not appear on the attached summary?
*
Please choose one...
Yes
No
Jewelry
Fine Art
Furs
Wine Collection
Firearms
Golf Equipment
Other...
Please specify...
Volunteer Activities
Is there any business activity or hobby operating out of your home or on your property?
*
Please choose one...
Yes
No
Please describe...
*
Do you have any tools or equipment stored at your home which are used in a business?
Yes
No
Miscellaneous Homeowner Information
I have a central alarm and it monitors:
Fire
Burglar
Low Temp
Do you have a swimming pool?
Please choose one...
Yes
No
Is it fully fenced in?
Please choose one...
Yes
No
I employ domestic help such as a baby-sitter, nanny, housekeeper, caregiver, gardener, etc. How many hours weekly?
Thank you for taking the time to complete this important form. Please comment in the space below if there is anything we could do better or different to improve on your service and relationship with Avery Insurance.
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