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Alabama
Alaska
American Samoa
Arizona
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California
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Connecticut
Delaware
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Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Michigan
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Mississippi
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Pennsylvania
Puerto Rico
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South Carolina
South Dakota
Tennessee
Texas
Utah
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Armed Forces Europe
Armed Forces Pacific
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We use a number of great partner carriers and I’d like to start by asking you some core underwriting questions that will help me immediately hone in on or eliminate some options for us.
Have you had any home claims in the past 5-yrs? If so, what and when?
Do you have any dogs? If so what breed?
Have you or any insured driver in your home had any accidents or major moving violations (DUI) in the past 5-yrs?
What other agents/carriers have you contacted for quotes? I don’t want to potentially replicate something you’ve already seen OR help ensure I can highlight important differences for you.
Are you aware of any pre-existing conditions with your home’s mechanical systems, including your roof that will be unrepaired prior to closing
Yes
No
Trees overhanging or touching the home?
Yes
No
Roof Age/Type:
HVAC Age/Type:
Electrical Age/Type:
Water Heater Age/Type
Type of home (single family/townhome/condo)
Type of purchase (investment home, primary home, secondary home, etc…)
Closing Date or Date Coverage Is Needed
Purchase price
Year Built
County
SQ Ft
Bathrooms
Fireplaces
Outbuildings (are outbuildings metered separately or rented to others?)
Exterior Finish
Foundation
Woodstove
Yes
No
Please provide details about your woodstove
Pool
Yes
No
Please provide details about your pool
Trampoline
Yes
No
Please provide details about your trampoline
Children
Yes
No
# of Children & Ages
Flooring
Carpet
Hardwood
Tile
Vinyl
Laminate
Carpet Percentage (%)
Hardwood Percentage (%)
Tile Percentage (%)
Vinyl Percentage (%)
Laminate Percentage (%)
Garage Type
Attached/Built In
Detached
Carport
None
Garage Capacity (Number of Cars)
1
2
3
4
5
Alarm System
Do any household residents smoke?
Yes
No
Are you a AAA member?
Yes
No
Mem#
Do any named insureds have a college degree/graduate/vocational?
Is there any business usage or operations out of the home?
I want to make sure we present underwriting exposures correctly to carriers as well as apply the correct discounts you could be eligible for. Do you own any second homes, rental properties, boats, drones, or recreational vehicles (ATV’s/RV’s) ?
Do you have any Jewelry, artwork, or collectibles that you’d like coverage riders for?
Who is your current HOI with?
Notes
Auto
Vehicle
Make/Model
Use/Yrly Miles
VIN
Comp/Coll
BIPD
Drivers
First Name
Last Name
Birthdate
Month/year first licensed
DL #
Good Student?
Drivers Contact/Job Details
Driver Name
Job Details
Renewal Date
Insured with
Limits
How do they pay / how much
Any tickets / accidents / claims in last 5 years
Are any vehicles used for uber/lyft/delivery?
Are all vehicles titled in the name of the insured?
Does insured own any vehicles not garaged at this location?
May I quote any of boats, motorcycles, or campers/travel trailers if uncovered above?
Yes
No
Life
Who do you have life insurance with outside of work?
How much/term length/cost?
IF at work only, what is the benefit amount?
We include a simplified issue no-needle stick coverage sample (if client is under 40) for all of our clients, because it makes a major impact on their discounts and is critical for family protection. I’d like to ask you 3-4 quick questions so we can include that sample:
Height
Weight
Do you smoke?
What medications do you take?
Do you have any health conditions of any kind?
Notes
Agent
*
Agent
Mike
Charlotte
Kelley
Nathan
Samantha
Bennett
Derek
Taylor
Linda
David
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