Personal Account Review Questionnaire

First Name

Last Name

Address

City

State

Zip Code

Home Phone

Mobile Phone

Email Address

Have you completed any renovations or additions to your home/property? (Pool, dock, gazebo, deck, fencing, roof or window replacement, other improvements) Have you completed any renovations or additions to your home/property? (Pool, dock, gazebo, deck, fencing, roof or window replacement, other improvements) Yes No

Do you own any other properties that we don't currently insure? (Secondary residence, rental property, vacant land, etc.) Do you own any other properties that we don't currently insure? (Secondary residence, rental property, vacant land, etc.) Yes No

Do you have any residence employees? (Nanny, housekeeper, etc.) Do you have any residence employees? (Nanny, housekeeper, etc.) Yes No

Do you have any income producing hobbies or operate a business out of your home? Do you have any income producing hobbies or operate a business out of your home? Yes No

What is the type of business or hobby?

Are you renting out any part of your home? Are you renting out any part of your home? Yes No

Do you have personal property that should be scheduled (appraisals may be required)? (Jewelry, coins, stamps, artwork, collectibles, etc. are limited in coverage on the standard policy) Do you have personal property that should be scheduled (appraisals may be required)? (Jewelry, coins, stamps, artwork, collectibles, etc. are limited in coverage on the standard policy) Yes No

Is there an unfenced pool on the premises? Is there an unfenced pool on the premises? Yes No

Are there any dogs, horses, exotic pets or farm animals on premises? Are there any dogs, horses, exotic pets or farm animals on premises? Yes No

If yes, what type(s) breed and how many?

Do you plan on Refinancing in the next 6 months? Do you plan on Refinancing in the next 6 months? Yes No

Do you plan on moving or buying another property in the next 6 months? Do you plan on moving or buying another property in the next 6 months? Yes No

Is every person in your household who holds a driver's license listed as a driver on your policy? Is every person in your household who holds a driver's license listed as a driver on your policy? Yes No

Is anyone who regularly drives one of your vehicles listed as a driver on the policy? (A housekeeper or nanny who regularly drives your vehicle)? Is anyone who regularly drives one of your vehicles listed as a driver on the policy? (A housekeeper or nanny who regularly drives your vehicle)? Yes No

Are all vehicles you own listed on your policy? Are all vehicles you own listed on your policy? Yes No

Do you drive any vehicles furnished for your regular use that you do not own? (Company car) Do you drive any vehicles furnished for your regular use that you do not own? (Company car) Yes No

Are all the vehicles listed on your policy titled to you and/or your spouse? Are all the vehicles listed on your policy titled to you and/or your spouse? Yes No

Are any of the vehicles garaged at a different address? (A child away at school with a vehicle) Are any of the vehicles garaged at a different address? (A child away at school with a vehicle) Yes No

Are any vehicles used in business, for sales, Uber, Lyft or deliveries, etc.? Are any vehicles used in business, for sales, Uber, Lyft or deliveries, etc.? Yes No

Do you own any recreational vehicles or watercraft? Do you own any recreational vehicles or watercraft? Yes No

Do you own any motorcycles, mopeds, minibikes or scooters? Do you own any motorcycles, mopeds, minibikes or scooters? Yes No

Please tick the boxes for the types of protection you're interested in learning more about: Please tick the boxes for the types of protection you're interested in learning more about: Umbrella Liability (An additional layer of liability over your home & auto policies) Flood Insurance Business Insurance or Employee Benefits Life, Disability, Long Term Care Insurance or Annuities Pet Insurance Home Warranty Insurance

How do you prefer we contact you? Check your preferred methods: How do you prefer we contact you? Check your preferred methods: Telephone / Mobile Phone Email SMS / Text Mail