SWFL Insurance Agency, Inc.  /    Family Risk Questionnaire

Please Compete and Return so we may update your account

Customer:                                                       Phone:                                Email:

Auto Insurance

If we do not provide your auto Insurance, can we provide a Proposal? Yes _____  No _____

Do you presently carry adequate Liability and Uninsured Motorist coverage?   Yes _____  No _____

How much is your net worth?  You should have liability limits to protect this wealth.

Can we provide you with a quote for increased Liability and Uninsured Limits?   Yes____   No___

Do you have electronic device/equipment that has not been declared?  Yes____  No _____

Do you have regular use of a vehicle that you do not own? Yes____  No _____

Do you need Rental Reimbursement and Towing and Labor coverage?  Yes____  No_____

Have any vehicles been titled to a Trust or another family member?  Yes ____  No______

Do you have recreational vehicles (boats, motorbikes, motor homes, golf carts, LSV? Yes ____  No______

Do you have any vehicles not listed on this policy? Yes ____  No______

Do you have drivers or persons who live in household not listed on policy? Yes ____  No _____

Home Owners Insurance/  Condo Owners Insurance

If we do not provide your Home or Condo Insurance, can we provide a Proposal? Yes ___No___

Costs of construction of homes increases every year.  Insured values should be reviewed each year.

Are your home and contents insured to 100% replacement cost?  Yes ___No___

Do you carry adequate Additions and Alterations for your condo?    Yes ___No___

Do you rent your home or condo to others?    Yes ___No___

Valuable items such as jewelry, furs, silver, guns typically have limited coverage under the HO Policy.

Do you have valuable items that need to be insured?  Yes_____  No_____

Are you interested in higher Liability Coverage Limits ?  Yes_____  No_____

We recommend that you consider purchasing an Umbrella Liability Policy.  Can we quote?  Y__  N___

Are you interested in Personal Injury coverage (libel, slander, defamation)?  Yes_____  No_____

FLOOD coverage is not included in the Homeowners Policy?

Do you need a quote for flood insurance?  Yes_____  No_____

If Wind/Hurricane coverage is not included in your Homeowners Policy, do you need a quote? Y___N__

Do you need Excess Wind or Flood coverage?  Yes_____  No_____

Do you operate a business from your home?  Yes_____  No_____

Do you own rental property or vacant land or a farm?  Yes_____  No_____

Do you have domestic employees in your home?  Yes_____  No_____

Have any property deeds been changed to another family member or trust?  Yes_____  No_____

Do you have pets?  If so what kind?  ________________________

Do you have children living away from home or away at school?  Yes_____  No_____

Do you have a pool ?  Do you have an enclosure?  Do you need insurance?  Yes_____  No_____

Do you have a dock?  Do you have a boat?   What kind and size?  _____________________

Do you have a new roof or new hurricane protection?   Yes_____  No_____

Have there been other changes that we should be aware of?  Yes_____  No_____

Do you have a significant other, roommate, etc. living with you….No Liability or Property coverage is provided for them…….discuss with agency.

NOTE:  This may not be a complete listing of every possible risk exposure that your family may have, however this list does include the majority of the most common exposures that occur. Please discuss with us any situation in which you may not be sure of coverage.

Thank you for taking the time to review and respond to this questionnaire.  These are important considerations for your valuable insurance coverage.  We look forward to assisting you with any new quotes that you may request.  We Value and Appreciate your Business.

Please copy and print this list as needed.

Please call us at 239-265-9577 or email info@swflagency.com  with any questions or requests.

Thanks much.

SWFL Insurance Agency