Carrier - Underwriting Questions - Travelers

Home Underwriting Questionnaire

1. Have you had any primary or excess insurance declined, canceled, or non-renewed in the past 5 years??(Required)

Please describe(Required)

2. Do you have any primary policies (home, auto, etc) which eliminate or restrict any coverage?(Required)

Please describe(Required)

3. Any accidents or traffic violations in 5 yrs (auto, RV or Watercraft)?(Required)

Provide details(Required)

4. Do you have any Physical, medical or mental/emotional impairments?(Required)

Please provide details(Required)

5. Are you providing Medical statement with the application?(Required)

Upload Medical Statements

Max. file size: 10 MB.

6. Do you own, rent or operate any type of farm or farming operation?(Required)

Please provide details(Required)

7. Are you involved with unpaid civic duties, volunteer work or a non-profit corporations?(Required)

Please provide details(Required)

8. Do you travel to foreign countries more than 6 months per year?(Required)

Please provide details(Required)

9. Any liability claims or lawsuits against a household member in 5 yrs?(Required)

Please provide details(Required)

10. Do you own or lease any Real estate, vehicles, watercraft, aircraft that is not covered on a primary policy?(Required)

Please provide details(Required)

11. Aircraft owned, leased or charted for regular use?(Required)

Please provide details(Required)

12. Do you have any household employees/domestics?(Required)

Please provide # of employees and indicate if they reside at the premise.(Required)

13. Do you have a swimming pool at your house?(Required)

Is the pool In ground or above ground?(Required)

In Ground

Above Ground

Is the pool Fenced(Required)

Yes, it is fully fenced

No it is not fenced

14. Do you have animals or exotic pets?(Required)

Please provide details(Required)

Auto Underwriting Questionnaire

Landlord / Dwelling Fire Questionnaire

Umbrella Underwriting Questionnaire

Do you currently have an umbrella policy?(Required)

Yes

Please provide the company name and amount of insurance.(Required)

What is your Occupation?(Required)

How many Residences do you own/lease?(Required)

How many Vehicles do you own/lease?(Required)

How many Recreational Vehicles do you own/lease?(Required)

How many Motorcycles do you own/lease?(Required)

How many ATVs/UTVs do you own/lease?(Required)

How many Boats/Watercrafts do you own/lease?(Required)

How many Rental Properties do you own/lease?(Required)

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Admin Use Only

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Form Category

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Form Name

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Agency Name

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AMS ID

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CRM ID

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Internal Use

Yes

Travelers Underwriting Questionnaire

Home Underwriting Questionnaire

Auto Underwriting Questionnaire

Landlord / Dwelling Fire Questionnaire

Umbrella Underwriting Questionnaire

Admin Use Only

Travelers
Underwriting Questionnaire