Auto Insurance Renewal

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:

Policy Number:

Are you authorized by the policy holder to complete the following insurance review?


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.

Please confirm the following contact information:

Mailing Address:

Phone Number(s):

Email Address(es):


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)


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 PleaseNo 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 thought, let's do it!I'm sure.

Your Name:

Contact Number:

Preferred Review...
Date:

Time (select all that apply): MorningAfternoon

Location: HGA Insurance OfficeOther

Where?

Are you in need of any other HGA Group services?
Check the boxes you're interested in and we'll get you in touch with someone in that division!

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