Insurance Renewal Questionnaire

The insurance renewal questionnaire has to be filled by an insurance owner prior to renewal of their insurance policies. The main aim of the insurance renewal questionnaire is to get information from the insurance owner regarding their personal details, insurance details, and details of the object of insurance.

Sample Insurance Renewal Questionnaire:

Name of the Insurance Owner: _________________

Policy Number:____________________  Beneficiary: ___________________

Address: _____________________________ State: ________  Zip: _________

Phone Number: ______________

Email Address: ______________

Q1.  What type of insurance policy do you currently own?


Q2.  Do you want to renew the current policy along with any of the following policy?

  • Auto Insurance
  • Health Insurance
  • Home Insurance
  • Accident or unemployment Insurance
  • Casualty Insurance
  • Life Insurance
  • Burial Insurance
  • Pet Insurance
  • Property Insurance
  • Liability Insurance
  • Credit Insurance
  • Travel Insurance
  • Other Insurance

Q3.  Which of the following extra add-ons would you desire on your current insurance policy?

  • Legal expense
  • Collateral protection
  • Business interruption
  • Livestock
  • Bloodstock

Q4.  Do you wish to make any changes in your current insurance policy?

  • Yes
  • No

Q5.  Do you pay your premiums from your escrow account?

  • Yes
  • No

Q6.  Do you want to change the amount of premiums on your policy?

  • Yes
  • No

Q7.  Do you want to pay a higher deductible? Do you want to change the current policy to a higher deductible policy?

  • Yes
  • No

Q8.  If you do not have an umbrella policy currently, would you be interested in receiving a quote?

  • Yes
  • No

Q9.  Do you want to change the beneficiaries in your policy?

  • Yes
  • No

Q10.  Have you made any claims on your current policy? If yes, mention nature of claim.

  • Yes
  • No
  • Nature of claim:______________

Category: Insurance Questionnaire

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