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Personal Insurance Moving Risk Evaluation
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Insure Your Move
Please help us ensure your personal property is properly covered when it is being transported from one location to another.
What is your first name? *
*
What is your first name? *
What is your last name? *
*
What is your last name? *
What is your email address? *
*
What is your email address? *
What date will your personal property be packed and shipped? (Approximate)
What date will your personal property be packed and shipped? (Approximate)
MM slash DD slash YYYY
What date will it be installed at its new location? (Approximate)
What date will it be installed at its new location? (Approximate)
MM slash DD slash YYYY
What is the value of all the personal property you will be transporting in this move? (Approximate)
What is the value of all the personal property you will be transporting in this move? (Approximate)
Please select the types of high value property you will be transporting during your move.
Please select the types of high value property you will be transporting during your move. (Select all that apply)
Jewelry
Fine Art
Wine/Spirits Collection
Stamps and Coins
Firearms
Silverware/Goldware/Metalware
Fragile Articles (Mirrors, glassware, china, porcelains, etc...)
Watercraft
Vehicle
Other
What other type of valuable property will you be transporting?
What other type of valuable property will you be transporting?
What is the approximate value of the jewelry being transported?
What is the approximate value of the jewelry being transported?
Please select the security measures that will be utilized to protect your jewelry when in transit.
Please select the security measures that will be utilized to protect your jewelry when in transit.
Items transported in unmarked cases
Private security
Sent via private aircraft
None
What is the approximate value of the fine art being transported?
What is the approximate value of the fine art being transported?
What is the approximate value of the wine/spirits collection being transported?
What is the approximate value of the wine/spirits collection being transported?
What is the approximate value of the stamps/coins collection being transported?
What is the approximate value of the stamps/coins collection being transported?
What is the approximate value of the firearms collection being transported?
What is the approximate value of the firearms collection being transported?
What is the approximate value of the silverware/goldware/metalware collection being transported?
What is the approximate value of the silverware/goldware/metalware collection being transported?
What is the approximate value of the watercraft being transported?
What is the approximate value of the watercraft being transported?
What is the approximate value of the fragile articles being transported?
What is the approximate value of the fragile articles being transported?
Do you have a valuable articles policy in place to cover high value property while it is in transit?
Do you have a valuable articles policy in place to cover high value property while it is in transit?
Yes
No
Not sure
Will you be transporting any property that you do not own?
Will you be transporting any property that you do not own?
Yes
No
Not sure
What is the approximate value of the non-owned property being transported?
What is the approximate value of the non-owned property being transported?
Does the owner of the non-owned property you are transporting have coverage for their property?
Does the owner of the non-owned property you are transporting have coverage for their property?
Yes
No
Not sure
Will any of your personal property be placed into a storage facility as part of this move?
Will any of your personal property be placed into a storage facility as part of this move?
Yes
No
Not sure
What is the name of the storage facility?
What is the name of the storage facility?
What is the address of the storage facility?
What is the address of the storage facility?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Coverage Considerations
The following questions are designed to alert you to coverage areas that should be reviewed prior to transporting personal property.
Is your personal property coverage limit adequate to cover a total loss during this move?
Is your personal property coverage limit adequate to cover a total loss during this move?
Yes
No
Not sure
Is your deductible acceptable for this move?
Is your deductible acceptable for this move?
Yes
No
Not sure
Did you confirm that you have replacement cost coverage for your personal property while it is in transit?
Did you confirm that you have replacement cost coverage for your personal property while it is in transit?
Yes
No
Will you be staging a residence you are selling with rented furniture and other decorative property as part of this move?
Will you be staging a residence you are selling with rented furniture and other decorative property as part of this move?
Yes
No
Not sure
Disclaimer: This form is designed to assist with identifying some of the exposures to risk during a move. Some exposures may not be included in this question set.
Consent
*
Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
I agree *
Kris Pontell
4076961333
www.pontellinsurance.com
kris@pontellinsurance.com
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