Policy Review – Auto Policy Review - Personal Auto Accepting Coverages*Yes, I have.Not Interested.Your input is essential to eliminate gaps in your insurance coverage. Please accept that you have reviewed your policy, you accept your coverages and you have addressed any questions you have had with our team and/or insurance carrier. This checklist is used prior to the renewal of your insurance policy(ies) for the purpose of verifying your coverage is up to date to protect against losses. This checklist does not cover every situation, but it is a good starting point to prompt you to consider major items or questions. Date MM slash DD slash YYYY Client Name First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone - Best#*Text Messages*Yes - ApprovedNo - Do Not TextPlease let us know if you approve contact via text message.Email Preferred Method of Contact*Phone CallEmailTextHousehold Drivers Has there been any change in your household drivers? Ex. Drivers regularly using your vehicle, drivers that have moved out.Household Vehicles* Have there been any changes in the vehicles listed on your policy? Ex Vehicles sold, purchased, in storage, loaned out, customized or altered, refinanced or a loan paid offCustom Equipment* Do you have any custom equipment on your vehicle(s)? Ex Stereo systems, aftermarket parts, grill guards, etc. Other Vehicles & Business Use* Do you often drive vehicles owned by others, including your employer's vehicle? Or use your vehicle(s) for business reasons? Do you use your vehicles for ride-share Lyft, Uber, Turo or other? Annual Miles - Low Mile Discount*Please let us know the estimated annual miles driven by your vehicle(s). AAA Roadside Service* Are you a member of AAA Roadside Service? Other Insurance* Umbrella or Excess Liability Insurance Auto Homeowners or Renters Water or Sewer Pipe Coverage Flood Boat or Personal Watercraft Motorcycle or ATV Farm or Agriculture Business/Commercial Life/Health Insurance: We do not write but can offer a referral Are there any other coverages we can answer questions about or quote for you? Community Partnerships Did you know that for all referrals we receive, we donate to a local nonprofit? Is there an organization that is close to your heart that you want to share with us? Feedback*Do you have any feedback for us? Is there an area we can improve your experience? Is there a team member you'd like to give kudos to for their effort?