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Family Risk Review
Family Risk Review
Let Trustpoint Insurance help you get the right coverage.
Family Risk Review
Step
1
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7
14%
Purpose Statement
It is important to assess your insurance policies at least once a year.
A personal conversation with us is best and we hope to connect with you soon. This questionnaire will guide that conversation. So, please take a moment to answer the questions below and electronically sign and send.
For your convenience, here is a link to our privacy policy.
Trustpoint's Privacy Policy
Start now by clicking "Next".
Your Information
Named Insured (as it appears on policy declarations page)
*
Your Name (if not named insured)
Your Email
*
Your Phone
Contact Preference
*
Email
Phone
Please tell us the best time to reach you.
General Questions
Is there anything about your insurance that you would like to discuss or understand better?
*
Yes
No
Frequently asked questions are:
What are my liability and /or property coverage amounts?
Am I covered for . . .
flood - sewer backup - someone getting hurt at my house or in my car - identity theft - etc.?
What are my claim deductibles?
What is uninsured motorist coverage?
Do I need towing and rental coverage?
Not every example is necessarily included and/or based on changes in your circumstances may not be adequate.
Write your question(s) here.
*
Automobile Exposures
Are there any licensed drivers in your home not listed on our policy?
*
This may include: newly licensed children or family members that came to live with you.
Household drivers not named may be uncovered if they have a claim while driving your vehicle.
Yes
No
Please list the additional driver(s).
Are there any vehicles in your household that we do not insure?
*
Including recreational vehicles, such as
boats
,
jet skis
,
motorbikes
,
four wheelers
,
campers
,
motor homes
, etc.
Yes
No
Please describe the additional vehicles.
Do any of your vehicles have customized or special equipment?
*
Including items, such as
GPS systems
,
two-way radios
,
under dash stereo
,
camper shell
, etc.
These must be listed separately in our application to receive coverage for an added charge.
Yes
No
Please describe the custom/special equipment.
Are any vehicles available for your regular use that you do not own, such as a company car?
*
Yes
No
Please describe these vehicles.
Do you use your personal autos for any type of ride-share application?
*
(examples: Uber, Lyft, Via, Gett, Juno, Wingz)
Yes
No
Do you use your personal autos for any type of car-share application?
*
(examples: Sixt, Car2go, DriveNow, Getaround, Turo, Vaven, Urbi)
Yes
No
Homeowner Exposures
Have you made any improvements to home?
*
Examples include:
kitchen or bath
,
detached garage
,
finished basement
,
additions or extensions
,
pool or patio
,
shed or barn
,
heating or air conditioning
, etc.
These items can increase the value of your home and may not be automatically included in your coverage.
Yes
No
Please describe these improvements.
Do you own high value items that you want specifically listed on your policy?
*
Examples include:
jewelry
,
furs
,
collector's items
,
gold/silver
,
camera equipment
,
fine china
,
silverware
, etc.
These items are not automatically included in your coverage and may result in additional premium. In some cases an appraisal may be needed.
Yes
No
Please describe these items.
Do you own a second home or any other property such as a cabin, farm, or any income-producing property?
*
Yes
No
Please describe the property.
Do you conduct any type of business, farming or ranching activity from your home?
*
These activities are not automatically insured. We must collect more information to offer a separate quote.
Yes
No
Please describe the activity.
Would you like to hear about any of the following specialized coverage?
Please check all that apply.
Select All
Cyber
Flood
Earthquake
Service Line
Equipment Breakdown
Sinkhole
Other
Please describe other.
*
Miscellaneous Exposures
Is there any change in circumstances that you think may affect your insurance coverage?
*
Please remember to tell us about any changes in household residents, buying or selling cars or property as they occur. Let us know when you have made that last loan payment so we can add/remove the lienholder from your policy.
Yes
No
Please describe the changes.
Do you have a child in college living away form home?
*
Yes
No
Are you a board or committe member, director or officer of any nonprofit organizations?
*
Yes
No
Would you like a quote for an umbrella policy?
*
This coverage can provide additional liability limits up to $1,000,000.
Yes
No
Would you like a quote for life insurance ?
*
Yes
No
Comments
Please use this space to provide your agents with any comments or to expand on any previous answers.
Would you like a hard copy of our privacy policy mailed to you?
*
Yes
No
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