Personal Renewal Questionnaire - Corporate Four Insurance

PL Renewal

We appreciate your business and strive to provide you with the insurance program that best meets your needs. Your policy(ies) will renew soon, and we need your assistance. To make sure that we remain current with your insurance program, please take a moment to complete the following survey. If we do not hear from you, we will proceed as if there are no changes needed to your household insurance needs, and the insurance company will renew your policy(ies) per its renewal terms and conditions.

Name(Required)

First Last

Have there been any structural changes to your home, cabin, garage, etc. since your last insurance review?(Required)

Including but not limited to additions, pools, structural alterations, utility or roof updates, etc.

Yes

Please describe(Required)

Did you purchase, lease or dispose of any (licensed or unlicensed) motor vehicles since your last insurance review?(Required)

Including, but not limited to cars, trucks, recreational vehicles, boats, etc.

Yes

Please describe(Required)

Have any new drivers been licensed or any drivers moved from your household?(Required)

Yes

List the driver changes below(Required)

Please indicate if you need to add or remove, names, date of birth and driver's license numbers.

Have you purchased, leased or disposed of any real property, including vacant land or buildings, since your last insurance review?(Required)

Yes

Please describe(Required)

Is coverage needed for unique personal property or valuables that are not currently listed on your policy?(Required)

Including, but not limited to: Jewelry / Fine Arts / Computers or Electronic Equipment / Camera Equipment / Firearms / Furs / Musical / Collectibles / Sporting Equipment / Other

Yes

Check all that apply(Required)

Jewelry

Fine Arts

Computers or Electronic Equipment

Camera Equipment

Firearms

Furs

Musical Instruments

Collectibles

Sporting Equipment

Other

Please describe the personal property and provide the corresponding value(Required)

Do you rent a self-storage unit?(Required)

Yes

Describe the contents and provide the value of the contents.(Required)

Are you paid to use your vehicle for delivery of products (i.e., pizza) or people, including driving for Lyft, Uber, or any other transportation network company?(Required)

Yes

Please describe(Required)

Do you conduct business or work from home?(Required)

Yes

Please describe the business(Required)

Is business conducted in an outbuilding or detached garage?(Required)

Yes

Is anyone ever on premises for business purposes, including mail or courier services?(Required)

Yes

Please describe(Required)

Do you employ anybody personally either full-time or part-time?(Required)

i.e. nanny, caregiver, lawn service

Yes

Please describe(Required)

HOA deductibles are increasing significantly! If you own a condo or townhome, would you like to review your loss assessment coverage to make sure you have enough?

We recommend sending us your association bylaws, declarations or insurance requirements for review.

Yes

You may have an exposure for damage that is not covered by your homeowners policy. Would you like additional information on coverage for any of the following?(Required)

Flood / Sewer Backup / Earthquake / Service Line / Equipment Breakdown / ID Theft / Cyber Liability / Replacement Cost / Matching of Roof or Siding Buy Back / Loss Assessment / Special Perils Coverage

Yes

Please check all that you are interested to learn more about

Flood

Sewer Backup

Service Line

Equipment Breakdown

ID Theft

Cyber Liability

Replacement Cost

Matching of Roof or Siding Buy Back

Loss Assessment

Special Perils Coverage

Earthquake

Your exposure to a liability loss may exceed your policy limits even if you already have an umbrella policy. Additional limits of liability may be available. Would you like more information on obtaining higher liability limits?(Required)

Yes

We offer a variety of other types of insurance. Please check any other types that you are interested to learn more about.

Life Insurance

Health Insurance

Umbrella Insurance

Business Insurance

Long Term Care Insurance

Disability Insurance

Recreational Vehicle Insurance

Other

What other types of insurance would you like to learn more about?

What is your preferred contact email address?

We will only use this to communicate with you regarding your insurance and will never sell or share your email address with anyone.

Enter Email Confirm Email

What is your preferred contact phone number?

What is your home address?(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Insurance Review Disclaimer

We know that it is not practical or possible to insure every conceivable loss. It is, however, our intention to offer you an economically feasible insurance program that protects against the more common or more severe risks to your financial security such as the examples listed in this survey.

By submitting this form, you are not signing up for marketing, promotional, or otherwise unsolicited SMS. Corporate Four Insurance Agency reserves the right to reply to any SMS initiated by you for the duration of the topic raised. Please see our Privacy Policy for more details.

Name

This field is for validation purposes and should be left unchanged.

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