Personal Insurance Annual Questionnaire Please enable JavaScript in your browser to complete this form.Start Questionnaire - Step 1 of 8Named Insured:Thank you for placing your personal insurance with Skylands Insurance Group. It is important to periodically review your insurance program to determine that we are still providing you with the best insurance solutions for your needs. To assist us with this review, please take a few minutes to complete and return this questionnaire.NextWould you like to review the adequacy of the current insured value of your home, other structures or personal content coverages? We recommend that you review these coverages every year and advise us if changes need to be made.- Select -YesNoExplainHave you made any updates to your roof, electric, plumbing HVAC in the last 3 years?- Select -YesNoExplainHave you reviewed the named insured on your policies and do each of the policies have the correct information? i.c. LLC, Trust- Select -YesNoExplainIs your home vacant or rented to others? Do you list it on VRBO, Airbnb or similar?- Select -YesNoExplainIf you own a condominium/co-op, would you like to review your current coverages for any upgrades, alterations or permanently installed fixtures, personal contents or loss assessment? In most cases, these items are not covered under your association’s master policy.- Select -YesNoExplainDo you own a seasonal home, secondary home, timeshare, or any other property not listed on your policy?- Select -YesNoExplainPreviousNextThere are mold coverage limitations on standard homeowner policies. Are you interested in discussing mold protection?- Select -YesNoExplainFlood damages are excluded from standard homeowner policies. Are you interested in discussing flood & excess flood protection?- Select -YesNoExplainEarthquake damages are excluded from standard homeowner policies. Are you interested in discussing earthquake protection?- Select -YesNoExplainMany standard homeowner policies do not include, or have limited coverage for back up of sewers, drains & sump pump failure. Are you interested in discussing adding or increasing these coverages?- Select -YesNoExplainMany carriers institute hurricane and windstorm deductibles that are separate and higher than what is typical. Some policies exclude wind/hurricanes. Would you like to review your policy to determine what deductible amounts and coverage you have?- Select -YesNoExplainDo you own a pool? Do you participate in any pool sharing or renting?- Select -YesNoExplainCoverage is limited for increased cost of construction due to building codes. Let us know if you would like to review this.- Select -YesNoPreviousNextDo you or your resident relatives operate a business from your home, sell goods or have revenue generating hobbies?- Select -YesNoExplainDo you have any domestic employees working in your home? Many standard homeowner policies may provide limited Worker’s Compensation coverage or no coverage for domestic employees.- Select -YesNoExplainAre you interested in Employment Practice Liability coverages? Bonding? - Select -YesNoExplainThere is a rise in cybercrimes, identity theft & online breaches. Are you interested in Cyber Liability protection & Fraud coverage?- Select -YesNoExplainPreviousNextThere are special coverage limitations on jewelry, silverware, furs, collections, fine arts, antiques, guns, cameras, musical instruments, currency and more. Coverage for these items can be increased or scheduled. Would you like to review your coverages?- Select -YesNoExplainHave you reviewed the limits of your collections policy for updates?- Select -YesNoExplainHave you installed any protective devices such as permanent generators, central station alarm systems that report to your police or fire departments?- Select -YesNoExplainDo you own a drone?- Select -YesNoExplainPreviousNextDo you feel your current automobile coverages are adequate? Higher coverages may be available at competitive prices, such as liability, agreed value, uninsured/underinsured liability.- Select -YesNoExplainDo you want to make changes to your rental reimbursement and/or towing coverages?- Select -YesNoExplainAre there any automobiles in your household that are not listed on your insurance policy?- Select -YesNoExplainAre there any drivers in your household that are not listed on your insurance policy?- Select -YesNoExplainAre any of your automobiles customized?- Select -YesNoExplainDo you participate in ride sharing with any of your automobiles or do deliveries?- Select -YesNoExplainDo you use any of your automobiles to carry passengers for a fee, such as UBER or livery services?- Select -YesNoExplainHas the garage location of your vehicles changed? (If applicable)- Select -YesNoExplainHave you reviewed the agreed value limits of your vehicle to be sure they are accurate?- Select -YesNoExplainDo you own any recreational vehicles including boats that we do not insure?- Select -YesNoExplainPreviousNextAre you interested in a Personal Excess Liability Policy or higher liability limits than you currently have on your policies? An additional $1 million in liability coverage can cost approximately $200.- Select -YesNoExplainIf you have a Personal Excess Liability policy with Skylands Ins Group & you have other automobiles, recreational vehicles, watercrafts, or properties insured elsewhere, do you have liability limits of at least $300,000 on all your other personal insurance policies?- Select -YesNoExplainAre you interested in including uninsured/underinsured motorist coverage on your Excess Liability Policy?- Select -YesNoExplainAre you interested in Not For Profit Excess & Officers Liability or Employment Practices Liability?- Select -YesNoExplainAre you interested in a review of your coverage and discussing other options that may be available to you?- Select -YesNoExplainDo you have policies not with our office that can be bundled for greater discounts?- Select -YesNoExplainPreviousNextYour SignatureClear SignatureDatePrint Name *Please provide the following information and indicate your preferred method of contact.Phone NumberEmail Email *We appreciate you taking the time to complete this questionnaire. If you are not submitted using the electronic form, please remember to sign and return this document to us by mail, fax at 973-347-2597, email info@skylandsgroup.net, or our website www.skylandsgroup.net. Upon receipt, we will review your questionnaire, update our records and contact you if necessary. If we do not receive a completed questionnaire from you, the insurance carrier will renew your policies based on existing information on file and we will assume there are no changes to be made. Thank you for continued business and support. Sincerely, Rhonda Linnett Graber, CIC, CPRM President Skylands Insurance Group Layout Skylands Insurance Group 354 Route 206 South Flanders, NJ 07836 Skylands Insurance Group 1405 3rd Ave Spring Lake, NJ 07762 PreviousSubmit Download PDF
