Annual Review Questionnaire

Annual Review Questionnaire

Please let us know if any of your insurance needs have changed within the past year by circling yes or no to the questions we’ve provided below.

If these items are not properly addressed, they could lead to a gap in your coverage, an uncovered loss or an undiscovered savings.

Annual Review Questionnaire

1. I have married, divorced, had a baby or other major life event.

Yes

No

N/A

2. I have purchased or own land/buildings, other than my home not presently insured with Clark-Mortenson.

Yes

No

N/A

3. I have recently altered or renovated my home (especially changed the size or updated the roof, heat or electric).

Yes

No

N/A

4. I employ a worker for housework, yard work, etc.

Yes

No

N/A

5. I am interested in additional coverage for jewelry, guns, furs, antiques, fine arts, collectibles or silverware.

Yes

No

N/A

6. I share my home with a non-related person, boarder, foster child or someone with disabilities.

Yes

No

N/A

7. I have moved some of my contents to an offsite storage facility.

Yes

No

N/A

8. I have placed my home in a trust or deeded it to someone else.

Yes

No

N/A

9. I conduct business in my home (including day care, home office, internet auctions, home shows/ parties, etc.).

Yes

No

N/A

10. I use my vehicle for business purposes.

Yes

No

N/A

11. I own a travel trailer.

Yes

No

N/A

12. I have had a security system installed in the past year.

Yes

No

N/A

13. I have a non-owned vehicle furnished for my regular use (i.e., company car)

Yes

No

N/A

14. There are other licensed members of my household, not listed on my policy.

Yes

No

N/A

15. I am currently insuring a vehicle that is not registered and titled in my or my spouses name.

Yes

No

N/A

16. I am using my vehicle for a ride sharing service, i.e.: Uber, Sidecar, Wings & Lyft. (Traditional car pooling arrangements are not considered Transportation Networking Companies).

Yes

No

N/A

17. I am currently renting all or part of my residence - regularly, or on a short term basis, such as AIRBNB.

Yes

No

N/A

18. I have significantly modified my vehicle (ex: stereo system/made handicap accessible/paint/graphics).

Yes

No

N/A

19. I own a motorcycle or recreational vehicle which is currently uninsured.

Yes

No

N/A

20. I have a child who has a B Average/3.0 GPA not currently receiving a discount on my policy.

Yes

No

N/A

21. I have a child who is in college over 100 miles from my home.

Yes

No

N/A

22. I have retired or have changed my commute distance within the last year.

Yes

No

N/A

23. I have a vehicle insured on my policy that is not kept/stored at my house.

Yes

No

N/A

24. I am planning or have already booked an international trip.

Yes

No

N/A

OTHER INSURANCE: Would you like us to review any other insurance not presently insured with Clark-Mortenson? (could include: Vision, Dental, Flood, Life, Health, Trip Cancellation and Umbrella).

Yes

No

N/A

If you have answered yes to any of the above questions, we will contact you. Please provide your contact info below. Thank you.

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