Auto Insurance Renewal

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? *

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.

Information

Please confirm the following contact information:

Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

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?

Please Explain:

2. After reviewing your insurance renewal, can you confirm that the current coverages listed on all vehicles meet your current needs?

Please Explain:

3. After reviewing your insurance renewal, can you confirm that the current deductibles listed on all vehicles meet your current needs?

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?

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?

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?

Please explain:

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

Where?

Are you in need of any other HGA Group services?

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