Personal Umbrella Policy Questionnaire

Homeowners Policy Questions

How many residential properties – regardless of location – are owned by or rented to you or any member of your household?(Required)

Does PGI service your homeowner policy?(Required)

Yes

No

Please note, we require a copy of the current policy declaration page if it is not serviced by PGI. Could you provide a copy of it now?(Required)

Yes

No

Upload a copy of your declaration page(Required)

Max. file size: 512 MB.

Please upload a photo or scan of your current policy declaration page.

Please email a copy of the current declarations page to your Account Manager or pldocs@primegroupins.com

Automotive Policy Questions

How many automobiles are owned (titled or registered to), leased, rented, or regularly operated by you or any member of your household?(Required)

What is the total number of drivers? (Including drivers with a learner's permit or valid driver's license.)(Required)

Have any of the drivers acquired a moving violation within the last 3 years? (Include DWI/DUI incidents within the last 5 years)(Required)

Yes

No

Please explain.(Required)

Does PGI service your auto policy?(Required)

Yes

No

Please note, we require a copy of the current policy declaration page if it is not serviced by PGI. Could you provide a copy of it now?(Required)

Yes

No

Upload a copy of your dec page(Required)

Max. file size: 512 MB.

Please upload a photo or scan of your current policy declaration page.

Please email a copy of the current declarations page to your Account Manager or pldocs@primegroupins.com

Recreational Vehicles Policy Questions

Do you own any watercraft or jet ski?(Required)

Yes

No

How Many?(Required)

Do you own any motorcycles, golf carts, or ATVs?(Required)

Yes

No

How Many?(Required)

Do you own any RVs?(Required)

Yes

No

How Many?(Required)

Watercraft Policy Questions

Does PGI service your watercraft or jets policy?(Required)

Yes

No

Please note, we require a copy of the current policy declaration page if it is not serviced by PGI. Could you provide a copy of it now?(Required)

Yes

No

Upload a copy of your declaration page.(Required)

Max. file size: 512 MB.

Please upload a photo or scan of your current policy declaration page.

Please email a copy of the current declarations age to your Account Manager or pldocs@primegroupins.com

Motorcycle, Golf Cart, and ATVs Policy Questions

Does PGI service your motorcycle, golf cart, or ATV policy?(Required)

Yes

No

Please note, we require a copy of the current policy declaration page if it is not serviced by PGI. Could you provide a copy of it now?(Required)

Yes

No

Upload a copy of your declaration page.(Required)

Max. file size: 512 MB.

Please upload a photo or scan of your current policy declaration page.

Please email a copy of the current declarations age to your Account Manager or pldocs@primegroupins.com

Motorhome RV Policy Questions

Does PGI service your RV policy?(Required)

Yes

No

Please note, we require a copy of the current policy declaration page if it is not serviced by PGI. Could you provide a copy of it now?(Required)

Yes

No

Upload a copy of your declaration page.(Required)

Max. file size: 512 MB.

Please upload a photo or scan of your current policy declaration page.

Please email a copy of the current declarations age to your Account Manager or pldocs@primegroupins.com

Your Name(Required)

First Last

Email(Required)

Phone Number(Required)

Do you prefer to be contacted by phone or email?(Required)

Phone

Email

If you have any additional questions or comments, please use the space below to address them.

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Name

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