Personal Lines Renewal Review "*" indicates required fields Today's Date*Please Enter the name listed first on your insurance policies MM slash DD slash YYYY Name*Enter the name listed first on your insurance policies First Last Email*Please Provide Your BEST & PREFERRED Email Address Mobile Phone:*Text Messages*Please let us know if you approve contact via text message Yes - Approved No - Do Not Text Preferred Method of Contact*TextPhoneEmailOccupation 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? What is your spouse's occupation? Please confirm your address?*Simply to make sure we're working on the right profile. Street Address City State / Province / Region ZIP / Postal Code What insurance policies 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 Motorcycle / ATV / UTV Life Insurance Personal AutoDrivers*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. 12345Vehicle 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 ListedAre 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 Are you open to increasing your deductibles to save money?* 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.* HomeownersWho 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 SharingDo 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)*Are you open to increasing your deductibles to save money?*Higher deductibles have lower premiums. Higher deductibles also means more money our of YOUR pocket in the event of a claim. Yes, let's talk about other deductible options. No, I'm not comfortable increasing my deductible in the event of a claim. DISCLAIMER*In the event of a remarket opportunity, we want to make sure we're crystal clear on the exterior inspection expectations. The carrier will have a 3rd party inspector come to the property about 30 days after the policy starts. They will be looking at the overall condition to include but not limited to: Branches/limbs/trees overhanging the roof line. Roof conditions such as granular loss, lifting, curling, missing shingles, etc. Cracks in your driveway or other concrete paths to your house. Exterior siding conditions such as peeling paint, missing siding, holes in siding Fence issues such as missing planks, falling, rotten, etc. The carrier will require you to acknowledge and repair any of the issues reflected on the inspection report. Please discuss any questions with the agent assigned to your renewal journey. By checking this box, you are acknowledging paragraph below: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 PropertyWho 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 SharingDo you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other? Yes No Are you open to increasing your deductibles to save money?*Higher deductibles have lower premiums. Higher deductibles also means more money our of YOUR pocket in the event of a claim. Yes, let's talk about other deductible options. No, I'm not comfortable increasing my deductible in the event of a claim. DISCLAIMER*In the event of a remarket opportunity, we want to make sure we're crystal clear on the exterior inspection expectations. The carrier will have a 3rd party inspector come to the property about 30 days after the policy starts. They will be looking at the overall condition to include but not limited to: Branches/limbs/trees overhanging the roof line. Roof conditions such as granular loss, lifting, curling, missing shingles, etc. Cracks in your driveway or other concrete paths to your house. Exterior siding conditions such as peeling paint, missing siding, holes in siding Fence issues such as missing planks, falling, rotten, etc. The carrier will require you to acknowledge and repair any of the issues reflected on the inspection report. Please discuss any questions with the agent assigned to your renewal journey. By checking this box, you are acknowledging paragraph below: Umbrella PolicyAny 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 PolicyHave 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 TrailerHave 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 / UTVHave 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 InsuranceHave 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:*Policies you have elsewhere. 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 AutoWho's your current auto carrier:*Please select your carrier from the listAllied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)Please insert your auto carrier's name here:* What kind of vehicles do you have?Year, make, and modelWho are the household members of driving age?Name and date of birth How much are you paying monthly from your auto insurance?* Landlord / Rental PropertyHow many rental properties do you own?* Addresses of all rental properties:Who's your current rental property carrier:*Please select your carrier from the listAllied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in 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 HomeownersWho's your current home insurance carrier:*Allied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)What's your current home insurance premium: When was your roof last replaced?*Newer roofs create discounts and increase carrier appetite. RV / Travel TrailerWho's your current RV / Travel Trailer insurance carrier:Allied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)Please insert your RV / Travel Trailer carrier's name here: What kind of RV/Travel Trailer do you have?Year, make, and modelDo 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?* WatercraftWho's your current watercraft insurance carrier:Allied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)Please insert your watercraft carrier's name here:* What kind of watercraft do you have?Year, make, and modelHow much are you paying monthly?* Motorcycle / ATV / UTVWho's your current Motorcycle / ATV / UTV carrier:Allied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)Please insert your Motorcycle / ATV / UTV carrier's name here:* What kind of Motorcylce / ATV / UTV do you have?Year, make, and modelHow much are you paying monthly?* Farm or RanchWho's your current Farm or Ranch carrier:Allied TrustAllstateAmerican ReliableAONedgeASI (American Strategic Insurance)Bristol WestCentauriDairylandElephantEncompassFalconFloodProForemostGermaniaHagertyHippoHomeowners of AmericaInfinitiKemper AutoKemper HomeMercuryMetLifeNational GeneralNationwideProgressiveSafecoSafepointSageSureSouth & WesternState AutoSWYFFTThe HartfordTravelersTWIATX Security GeneralUniversal North AmericaUPCUS AssureUS LloydsWellingtonWright FloodOTHER (Carrier not in list)Please insert your Farm or Ranch carrier's name here: What activities are you doing on your farm or ranch?Farming, Hunting, etc.. Business / CommercialWhat 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?CAPTCHAUntitledHiddenVA Completing Form HiddenAZ Assigned Producer HiddenAZ Assigned CSR
