Auto Insurance Questionnaire

An auto insurance questionnaire is a questionnaire used for analyzing the insurance needs of an auto. This questionnaire is helpful for the company providing auto insurance and is filled up by the individual who wants to get his vehicle insured. The questionnaire has details of the vehicle like the year of manufacture and working condition.

Sample Auto Insurance Questionnaire

Name: First name: _______ Middle name: __________ Surname: _________

Address: Street address __________ City name ________ State name _________

Postal code _________

Auto garaging address (if different from above): Street address __________ City name ________ State name _________ Postal code _________

Residential Contact number: _____________ Mobile number: ________

Email id: _________________

Vehicle registration number: __________

1. What is the year of manufacture of the car?


2. How many years has it been since you have purchased the car?

a) Less than one year

b) More than one year

c) More than three years

d) More than five years

3. What is the make of the model?


4. Is there any loan on the vehicle?

a) Yes

b) No

5. Is the car used for personal use or other purpose, please specify?


6. Have you ever got your car majorly repaired in the past?

a) Yes

b) No

7. If the answer to the above question is yes, what was the reason for getting it repaired?


8. Do you have any of the following protective devices in your car?

a) Dual air bags

b) Anti lock breaks

c) Security system or alarm

Category: Insurance Questionnaire

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