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Auto Insurance
Commercial Insurance
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Our Trusted Partners
Contact
Auto Insurance Renewal
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Step
1
of 4
Overview
As circumstances change, we want to make sure that your insurance keeps up. Please complete the following checklist to help us ensure your policy continues to satisfy your needs.
Your Name:
*
First
Last
Policy Number:
Are you authorized by the policy holder to complete the following insurance review?
*
Yes
No
Unauthorized
This form may only be completed by the policy holder or an individual authorized by the policy holder. Please redirect this e-mail to the appropriate individual.
Next
Information
Please confirm the following contact information:
Mailing Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
Email
*
Next
1. After reviewing your insurance renewal, can you confirm that all of the vehicles listed are correct, and that no vehicles should be removed, or new vehicles should be added?
Yes
No
Please Explain:
2. After reviewing your insurance renewal, can you confirm that the current coverages listed on all vehicles meet your current needs?
Yes
No
Please Explain:
3. After reviewing your insurance renewal, can you confirm that the current deductibles listed on all vehicles meet your current needs?
Yes
No
Please explain:
4. Have there been any changes to the daily use of your vehicles? For example, do you have a longer commute to work, or have you started using your vehicle for business purposes?
Yes
No
Please explain:
5. Anyone who regularly operates your vehicle, or any drivers in your household who do not carry their own auto insurance, should be added to your policy as an approved driver. With this considered, are there any new drivers to add to your insurance?
Yes
No
For each driver please provide the following:
Full Name
Birthdate
Driver's License Number
List of tickets obtained within the previous 3 years (not photo radar)
Additional Driver #1
Additional Driver #2
Additional Driver #3
6. Have there been any other recent changes that may influence your auto insurance needs?
Yes
No
Please explain:
Next
We also recommend completing an in-person policy review with our commercial insurance specialist every five years.
Would you like to request an in-person policy review?
Yes Please
No Thanks
Are you sure? Declining regular insurance reviews can impact the results of future claims if you are found to be incorrectly insured.
On second though, let's do it!
I'm sure.
Contact Name:
*
First
Last
Contact Phone:
Preferred Date:
Preferred Time (select all that apply)
Morning
Afternoon
Location
HGA Insurance Office
Other
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