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Business Insurance Account Review Form

A structured guide an insurance agent uses to walk a client through recent business changes and spot coverage gaps.

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Name of Person Completing this Form*

Business Name*

Best Phone Number:

1. How many employees do you have?

Full Time:

Part Time:

2. What is your current gross annual employee payroll (excluding Owners)?

3. What are your gross annual receipts (sales) for your business operations?

4. Are there any new drivers (If we insure your business auto)?

Yes No

Have you paid off any of your vehicles?

Yes No

6. Have you had any change in ownership?NO

Yes No

If YES above, please provide details:

7. Have you purcased any new property or business equipment?

Yes No

7. Have you purchased any new property or business equipment?

Yes No

Questions to help identify potential coverage gaps

1. If an employee stole money from your business, would you want it paid back?

Yes No

2. Do you have any key employees that, in the event of their death, you would require time and money to replace?

Yes No

3. If your company were to be sued for $1,000,000 more than your business liability limits, where would you want the money to come from?

My Personal Assets Business Insurance I Haven't Thought About It Other

4. If a disgruntled employee sued you for an alleged wrongful termination, would you want your policy to cover it?

Yes No

5. Cyber liability insurance has become a significant exposure for many businesses. Would you like to discuss adding or upgrading this coverage for your business?

Yes No

6. If you have had any claims in the past 5 years, were they all handled to your complete satisfaction?

Yes No Not Applicable

7. Is there anything additional you would like us to know about that might affect your insurance program?

Thank you for completing this review with your insurance agent.

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