Skip to content

Join Our Team!
About
Coverages
- Personal Insurance
- Commercial Insurance
Service
Blog
Contact

Address: 18587 Sigma Road Ste 210
San Antonio, Texas 78258
Phone: (210) 708-3203
Email: service@myinsurancegroup.com

Join Our Team!
About
Coverages
- Personal Insurance
- Commercial Insurance
Service
Blog
Contact

Client Renewal Questionnaire

Renewal Questionnaire

This questionnaire if for clients that have Personal Insurance with us, such as home and auto insurance.

"*" indicates required fields

Today's Date*

MM slash DD slash YYYY

Client Name*

Please Enter the name listed first on your insurance policies

First Last

Are you married?*

Yes

No

What's your spouse's full name?*

Spouse's date of birth*

MM slash DD slash YYYY

What's your spouse's email?

What's your spouse's phone number?

Please confirm your address?*

Simply to make sure we’re working on the right profile.

Street Address City State ZIP Code

Mobile Phone:*

Text Messages*

Please let us know if you approve contact via text message

Email Address*

Please Provide Us With Your BEST AND PREFERRED Email Address

Preferred Method of Contact*

What personal insurance lines do you currently have with My Insurance Group?*

Personal Auto

Homeowners

Landlord

Flood

Renters

Stand Alone (Texas Windstorm)

Personal Umbrella

Watercraft

Recreational Vehicle / Travel Trailer

Motorcylce / ATV / UTV

Life Insurance

Personal Auto

Drivers*

Please List All Household Members Over The Age of 15 and provide Date of Birth. We will cross reference this list with the list we have on file to ensure accuracy.

How Many Vehicles Do You Currently Own?*

For the purpose of this review, we would like to know about your private passenger automobiles.

Vehicle 1*

Year Make and Model How many miles are driven a year Principal Operator

Vehicle 2*

Year Make and Model How many miles are driven a year Principal Operator

Vehicle 3*

Year Make and Model How many miles are driven a year Principal Operator

Vehicle 4*

Year Make and Model How many miles are driven a year Principal Operator

Vehicle 5*

Year Make and Model How many miles are driven a year Principal Operator

Additional Vehicles*

Please Provide the Details of All Other Vehicles Not Previously Listed

Are any vehicles on the policy used for transportation for hire, such as Uber or Lyft?*

Yes

No

Please list the vehicle(s) used for Rideshare*

Our clients save 18% annually when completing carrier telematics generally within 90 days. Are you interested? By the way, you can opt out so don't be nervous.*

Yes

No

Insureds who pay in full can save up to 10%. Are you interested?*

Yes

No

Do you have any additional questions, concerns, or feedback regarding your auto insurance policy?*

Yes

No

Please Describe your Questions, Concerns, or Provide Any Feedback.*

Homeowners

Who is your mortgage company? We need to make sure the right company receives the renewal invoice.*

Have there been any recent changes in your mortgage company information? Does anyone, except a mortgagee, have financial interest in your home? Do you have a second mortgage or home equity line of credit?

Any home updates or improvements?

Have there been any additions or updates to your home? Ex pool, solar panels, remodeling, additions, updates to the water, heating, plumbing, electrical or roof

Yes

No

If Yes, Please provide a value and description for all improvements*

What year was your roof last replaced?*

It’s imperative to have the roof age when addressing carrier appetite.

Home Sharing

Do you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other?

Yes

No

Do you have any pets?

Yes

No

Please describe the number, type, and breed of pets (if dogs)*

Do you have any additional questions, concerns, or feedback regarding your home insurance policy?*

Yes

No

Please Describe your Questions, Concerns, or Provide Any Feedback.*

Landlord / Rental Property

Who is your mortgage company? We need to make sure the right company receives the renewal invoice.*

Have there been any recent changes in your mortgage company information? Does anyone, except a mortgagee, have financial interest in your home? Do you have a second mortgage or home equity line of credit?

Any home updates or improvements?

Have there been any additions or updates to your home? Ex pool, solar panels, remodeling, additions, updates to the water, heating, plumbing, electrical or roof

Yes

No

If Yes, Please provide a value and description for all improvements*

Home Sharing

Do you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other?

Yes

No

Umbrella Policy

Any significant changes in your assets or net worth that may require an adjustment in your personal umbrella policy coverage limits?

Yes

No

If yes, please explain:

Have you added or changed any recreational vehicles, boats, or other property to include houses that might warrant additional liability coverage under your personal umbrella policy?

Yes

No

If yes, please list:

Any changes in your household, such as new drivers, family members moving in or out, or changes in employment status, that could affect your personal umbrella policy coverage?

Yes

No

If yes, please explain:

Watercraft Policy

Have you made any modifications or purchased new equipment for your watercraft in the past year that may require an update to your policy?

Yes

No

If yes, please explain to include value:

Has your watercraft usage changed, such as frequency of use, different bodies of water, or participating in new activities (e.g., water sports, fishing, or chartering), which may impact your policy?

Yes

No

If yes, please explain:

Have there been any changes to the storage or mooring location of your watercraft, or have you transported your boat to new locations that might affect your watercraft policy?

Yes

No

If yes, please explain:

RV / Travel Trailer

Have you made any upgrades or purchased new accessories for your RV or travel trailer in the past year that may require updates to your insurance policy?

Yes

No

If yes, please explain to include value:

Has there been a change in frequency of use such as taking longer trips, participating in new activities, or riding in different locations, that could affect your insurance policy coverage?

Yes

No

If yes, please explain:

Are you renting your RV or Travel Travel to others?

Yes

No

Are you using a program such as RVshare or Outdoorsy?

Yes

No

Motorcycle / ATV / UTV

Have you made any upgrades or purchased new accessories for your motorcycle or ATV/UTV in the past year that may require updates to your insurance policy?

Yes

No

Please explain:

Life Insurance

Have there been any life events in the past year such as marriage, divorce, birth or adoption of a child, or a change in dependents that could affect your life insurance coverage needs?

Yes

No

Please explain:

Have you experienced any changes in your financial situation such as an increase in income, assets, or debt that might warrant a re-evaluation of your policy coverage amount or type?

Yes

No

Please Explain:

Have you made any updates to your estate plan or designated beneficiaries for your life insurance policy in the past year?

Yes

No

Please explain:

Do you need assistance reviewing or updating this information to ensure it is accurate and up-to-date?

Yes

No

Finally…

What policies do you have outside of My Insurance Group:*

Auto

Rental Property(ies)

Personal Umbrella

RV or Travel Trailer

Homeowners

Life / Mortgage Protection

Flood

Watercraft

Motorcycle or ATV

Farm or Ranch

Business/Commercial

None at this time

Personal Auto

Who's your current auto carrier:*

Please select your carrier from the list

Please insert your auto carrier's name here:*

What kind of vehicles do you have?

Year, make, and model

Who are the household members of driving age?

Name and date of birth

How much are you paying monthly from your auto insurance?*

Landlord / Rental Property

How many rental properties do you own?*

Addresses of all rental properties:

Who's your current rental property carrier:*

Please select your carrier from the list

Please insert your rental property carrier's name here:*

Do you use this property for short term rentals such as AirBNB or VRBO*

Yes

No

Do you require the tenants to have tenant insurance?*

Yes

No

Are the property(ies) professionally managed?*

Yes

No

Homeowners

Who's your current home insurance carrier:*

What's your current home insurance premium:

When was your roof last replaced?*

Newer roofs create discounts and increase carrier appetite.

RV / Travel Trailer

Who's your current RV / Travel Trailer insurance carrier:

Please insert your RV / Travel Trailer carrier's name here:

What kind of RV/Travel Trailer do you have?

Year, make, and model

Do you use a rent your RV / Travel Trailer to others?*

Yes

No

Do you use a rental program such as RVShare or Outdoorsy?*

Yes

No

How much are you paying monthly?*

Watercraft

Who's your current watercraft insurance carrier:

Please insert your watercraft carrier's name here:*

What kind of watercraft do you have?

Year, make, and model

How much are you paying monthly?*

Motorcycle / ATV / UTV

Who's your current Motorcycle / ATV / UTV carrier:

Please insert your Motorcycle / ATV / UTV carrier's name here:*

What kind of Motorcylce / ATV / UTV do you have?

Year, make, and model

How much are you paying monthly?*

Farm or Ranch

Who's your current Farm or Ranch carrier:

Please insert your Farm or Ranch carrier's name here:

What activities are you doing on your farm or ranch?

Farming, Hunting, etc..

Business / Commercial

What kind of business do you own?

We love feedback!!

Do you have any feedback for us? Is there an area we can improve your experience?

CAPTCHA

Untitled

Hidden

VA Completing Form

Contact Info

Address: 18587 Sigma Road Ste 210
San Antonio, Texas 78258
Phone: (210) 708-3203
Email: service@myinsurancegroup.com
Opening hours 9AM - 5PM

Quick Links

Get Quotes
Contact Us
Privacy Policy
Accessibility

Copyright © 2024 My Insurance Group - Integra - Powered by Advisor Evolved

Call Email Claims Payments

Have A Question?

×

Send Message In App