A vehicle insurance questionnaire is used by the individuals who wish to get their vehicle insured. This questionnaire is also helpful for the company providing vehicle insurance as it helps them to assess the eligibility of the individual applying for the insurance. The questionnaire has details of the vehicle like the year of manufacture and make and type of vehicle.

Sample Vehicle Insurance Questionnaire

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

Address: Street address __________ City name ________ State name _________

Postal code _________

Vehicle 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. Is the vehicle a personal vehicle or a commercial vehicle?

a) Personal vehicle

b) Commercial vehicle

2. What kind of vehicle is it?

a) Car

b) Motor bike

c) Scooter

d) Truck

e) Van

3. How many years has it been since you have purchased the vehicle?

a) Less than one year

c) More than one year

d) More than three years

e) More than five years

4. Have you ever met with accident while driving the vehicle?

a) Yes

b) No

5. If answer to the above question is yes, did the vehicle get damaged?

a) Yes

b) No

6. What kind of security measures are there in the vehicle?


7. What is the average total number of kilometers, the vehicle is driven annually?

a) Less than thousand kilometers

b) More than thousand kilometers