Annual Insurance Review Questionnaire Form

Name

First NameLast Name

Email

example@example.com

Cell phone

Please enter a valid phone number.

1. What is your annual household income?

Below $60,000$60,001 to $120,000Over $120,001Prefer not to answer

2. Have you had any life changes in the last year? Have you added a driver, or a car? Have you moved, refinanced, planning to move, or had a renovation to your home?

YesNoMaybe?Prefer not to answer

3. How much equity do you have in your home?

4. Who is your life insurance with?

I don't have any life insuranceI have some life insurance through my employer.I have life insurance elsewherePrefer not to answer

* Why are we asking these questions? The short answer is Asset Protection!

If you make less than $60,000 annually, you should have auto liability coverage of at least $100,000 per person. In Ohio, if the court deems you responsible for an accident, and you have inadequate coverage, they can garnish your wages up to 25% of your annual income, for up to 10 years. In addition, the court can empty your savings and checking accounts for everything except $425. They may also take the equity in your home, over $125,000.

If you make between $60,001 to $120,000 you should have auto liability coverage of at least $250,000 per person.

If you make over $120,001, it is recommended you have a personal umbrella policy for at least $1,000,000. (FYI: Personal Umbrella policy are the best bargin in the insurance industry, they usually cost around $300 per year.

For life insurance, we want to make sure you have enough, no matter who you have it with. It is recommended that you have life insurance 10 to 12 times your annual income. This should adequately protect those who are dependent on your income.

5. Who is your Emergency Contact? (someone who doesn't reside with you)

Name: First & Lastphone number

Emergency Contact email:

example@example.com