The Stammen Companies : Insurance and Financial Services : Personal Insurance Services : Personal Insurance Checklist

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Personal Insurance Checklist

Customer Service

Personal Insurance Checklist

Fields in bold are required

Name:
Address:
City:
State:
Zip:
Phone Number:
Best Time To Call:
E-mail Address:

Checklist Questions:

Do you have collectibles such as antiques, fine arts, stamps, coins, or baseball cards?	Yes No
Do you own valuable jewelry or furs?	Yes No
Do you own costly sporting equipment or firearms?	Yes No
Do you have valuable cameras or other photography equipment?	Yes No
Do you own a computer? Desktop Laptop	Yes No
Do you own a snowblower or garden tractor?	Yes No
Do you own any farming equipment?	Yes No
Do you have any alarms installed in your home? Type of alarm:	Yes No
Are your personal belongings insured for their full replacement value?	Yes No
Do you have children away at college?	Yes No
Do you own tools, equipment, or instruments used in your trade or profession?	Yes No
Do you operate an office or studio in your home?	Yes No
Do your clients come into your home to make purchases?	Yes No
Do you provide day care services in your home?	Yes No
Have you recently remodeled or redecorated your home?	Yes No
Do you have plans to remodel or redecorate in the near future?	Yes No
If your home suffered an entire loss, would your insurance cover your home's full replacement cost?	Yes No
Do you have any detached buildings on your property?	Yes No
Are you interested in Flood Insurance for your home and personal property?	Yes No
Do you have a wood burning stove?	Yes No
Do you have a swimming pool?	Yes No
Do you have a hot tub?	Yes No
Do you have a trampoline?	Yes No
Do you own any animals/pets? Type:	Yes No
Do you own rental or investment property?	Yes No
Do you own a vacation home?	Yes No
If you rent, do you carry Renter's Insurance?	Yes No
Do you plan to purchase a new vehicle this year? Would you like us to provide an insurance estimate on the vehicle(s) you are considering? If so, please enter the type of vehicle(s):	Yes No
Does our agency insure all of your vehicles?	Yes No
Does your automobile policy specify all of the drivers in your household?	Yes No
Do you routinely use vehicles you do not own or are you furnished a vehicle by your employer?	Yes No
Do you store CD's or cassette tapes in your car?	Yes No
If your vehicle were in an accident, would your current automobile insurance reimburse you for a rental vehicle while yours is being repaired?	Yes No
Do you own any of the following? Boat Golf Cart Camper Moped All-Terrain Vehicle Personal Watercraft Snowmobile Motor Home Other:
Do you carry at least a one million dollar Umbrella Liability policy?	Yes No
Do you own a business?	Yes No
If yes, do we currently insure it?	Yes No
Would you like a no-obligation review of your life insurance needs for your business?	Yes No
Do you and your family have health insurance coverage?	Yes No
Do you have Disability Income Insurance?	Yes No
Do you have life insurance which pays your mortgage in case of your death?	Yes No
Are you insured for long-term supervised health care?	Yes No
Do you know anyone else who could benefit from a no-obligation insurance review from our agency? Name: Phone Number:
Comments:

Personal Auto Insurance

Home/Renters Insurance

Business Insurance

Download this FREE program from the Insurance Information Institute to easily develop a home inventory.

We‘ve compiled this checklist to help you identify areas where your insurance coverage can be improved.

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Securities offered through Capital Analysts Incorporated: A Broker-Dealer, Member NASD/SIPC
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