Insurance Professionals of TN_19-0863-00

It’s time to review your insurance.

It’s important to review your needs to ensure you have the proper coverage in place.

Client Information

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

What insurance do you currently have with us?*

Personal InsuranceBusiness Insurance

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Home(s)

Please think back over the last year when answering these questions.

Have you remodeled or made any major updates to an existing home(s)?

YesNo

Have you added a home security system?

YesNo

Have you started a home-based business?

YesNo

Have you purchased a secondary residence, including a condo or timeshare?

YesNo

Have you started participating as a service provider in the home sharing economy? (Airbnb, VRBO)

YesNo

Please explain any changes to your home.

Your Automobiles and other "Vehicles"

Please think back over the last year when answering these questions.

Have you added an automobile, watercraft, or recreational vehicle?

YesNo

Have you added any new drivers?

YesNo

Have you added a vehicle provided by an employer?

YesNo

Have you had a child leave home to attend school or no longer considered a dependent?

YesNo

Have you started participating as a service provider in the ridesharing economy? (Uber, Lyft, Sidecar)

YesNo

Please explain any changes to your automobiles and "other" vehicles.

Your Other Life Events

Please think back over the last year when answering these questions.

Have you added or changed ownership of any assets including titles, trusts or LLCs?

YesNo

Have you hired domestic help, nanny or housekeeper, either full or part-time?

YesNo

Have you purchased jewelry, art or other valuables that need to be added? Are there items that need to be changed or deleted?

YesNo

Have you had a significant change in net worth?

YesNo

Have you accepted a position on a board(s) of a profit or nonprofit organization(s)?

YesNo

Please explain any changes.

Additional Protection

Would you like to discuss any additional insurance protection with us?

YesNo

Company Name

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Total Annual Sales

Total Number of Employees

Your Business Structure

Please think back over the last year when answering these questions.

Have you changed the ownership structure of your business?

YesNo

Have you added new or changed your existing operations and/or products?

YesNo

Have you begun to buy supplies or sell your products overseas?

YesNo

Are you operating out of any new locations or have you closed locations?

YesNo

Please explain any changes to your business structure.

Your Personal Liability

Please think back over the last year when answering these questions.

Have you acquired, leased or sold a building, business property and/or equipment?

YesNo

Have there been any improvements and/or significant alterations to your building?

YesNo

Has your Inventory level changed significantly?

YesNo

Have you purchased, leased or sold any Vehicles?

YesNo

Please explain any changes to your personal liability.

Your Income Protection

Please think back over the last year when answering these questions.

Have your Businesses revenues changed by more than 10% since last year?

YesNo

Do you rely on a single supplier for more than 50% of your materials?

YesNo

Do you rely on a single buyer for more than 50% of your sales?

YesNo

Please explain any changes to your income protection.

Your Employees & Professional Liability Exposure

Please think back over the last year when answering these questions.

Do you have employees that regularly travel out of state or overseas for business?

YesNo

Do any employees use their own personal cars for business purposes?

YesNo

Do any Employees work outside your home state or work from their home regularly?

YesNo

Do you obtain Certificate of Insurance from all subcontractors, vendors and 1099 workers?

YesNo

Are any of the owners a member of any board of directors whether for profit or not?

YesNo

Please explain any changes to your employees and personal liability exposure.

Additional Protection

Would you like to discuss any additional insurance protection with us?

YesNo

Other Comments, Questions or Concerns:

Please verify that you are human*

Policy Review