Insurance Service Center DePere - Separation Insurance Checklist

Client Name*

First NameLast Name

Email Address

Procedures of Insurance Center:

In the cases of divorce or separation, it is the practice of the agency to do our best to keep both parties aware of any changes made to the insurance policy. We will attempt to obtain both signatures prior to making a change to the policy, or canceling the policy, when applicable.
If allowed by your insurance company, we will add a second mailing address (if applicable) to your policy to allow for both of you to receive copies. Not all companies will allow this.
We will provide copies of policies, as requested, by either party.
We will provide copies of policies, as requested, by either party.
If a client has a unique situation, we will make every attempt to accommodate their wishes, but we cannot make any guarantees.

A copy of this form will be mailed to both husband and wife, please answer the questions as they pertain to YOU.

Name:

What date do you anticipate the divorce will be finalized?

Have you moved out of the primary home?

YesNoCall Me

If yes, what is your new address?

If yes, what is your new phone number?

If yes, is there any reason we may not list your new address as a secondary location on your insurance policies (Your spouse will be able to see your address if we do this)?

If yes, do you need a renter’s insurance quote?

YesNo

HOMEOWNERS or RENTERS INSURANCE POLICIES

Do you have any personal property in storage?

YesNoCall Me

AUTO INSURANCE POLICIES

Which vehicle(s) are in your possession at this time?

Are the vehicles in your possession titled in your name, your spouses name or both names?

Your NameSpouse's NameBoth

Please tell us about any special requests or concerns?

Do you have youthful drivers on your policy?

YesNoCall Me

If yes, at which address will they primarily be staying?

Comments

I have read the above and have personally reviewed the answers above. I understand that it is my responsibility to advise Insurance Service Center of any special insurance needs I may have and that this checklist does not imply, in any manner, that these are the ONLY items that may be of concern to me.

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