Life Changes Simple Survey Life Changes: And So Does Insurance Please let us know about any recent life changes so we can review your coverage options as your renewal approaches.This should only take 1-3 minutes to complete. Life Changes Simple Survey Primary Insurance Contact(Required)Who should we contact about your insurance policy? First Last Preferred Phone(Required)Preferred Email(Required) Has your mailing address changed?(Required)Has your mailing address changed in the past 12 months? Yes No Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Have you had any family changes?(Required)E.g. new child, marriage, divorce, death of spouse, child moving out Yes No Has there been a change in the number of drivers living in the house?(Required) Yes No Can you describe these changes?(Required)Driver changes could qualify you for additional discounts. For example, we offer several discount options for teen drivers. Has anyone changed jobs?(Required)Has anyone in your household changed jobs in the last 12 months? Some changes could qualify you for additional discounts. Yes No Do you own a business?(Required) Yes No What type of business do you own?(Required) Is your business in-home?(Required) Yes No Have you earned a degree or certification since your last renewal?(Required) Yes No Type of degree or certification(Required) Have your driving habits changed?(Required)Factors such as working from home, using your vehicle for work (e.g. Uber, Doordash, contractor, realtor), or advertising for your business on your vehicle could impact your exposures and coverage, or qualify you for additional discounts. Yes No Tell us about any changes in driving habits(Required) Have you or do you plan to do any home improvements?(Required) Yes No N/A Tell us about your home improvements and the approximate value of changes(Required) Do you have any special personal property that you need to insure?(Required)Items such as jewelry, weapons, fur coats, musical instruments, fine china, fine art, or high-end bicycles may require special coverage to protect you against theft, breakage, or mysterious disappearance. Yes No I already have coverage List the items and their approximate value(Required) Would you like a quote for an umbrella policy?(Required)A personal umbrella policy will protect you from having to pay out-of-pocket if a claim exceeds the limits on your policy. This inexpensive coverage is highly recommended by our agency and by financial experts such as Forbes and Dave Ramsey. Yes No I already have an umbrella policy Would you like a quote for identity theft/fraud protection?(Required) Yes No I already have this coverage Do you have life insurance outside of your employer?(Required)Many times this life insurance does not follow you if you leave your current job. Yes No Are you interested in receiving an affordable life insurance quote?(Required)If you already have life insurance with your employer, we can see if we can save you money compared to what you are currently paying. Yes No Are you interested in reviewing health insurance or health share options?(Required)Even if you’re currently insured, it’s worth having a review of your current coverages/costs. Yes No Additional items to insure (that Veritas does not already insure)?(Required) RV Boat/Jet Ski Motorcycle ATV Rental Property Vacation Home Other N/A What additional item not listed do you need to insure? Is there anything else we should be aware of as your renewal approaches? Documents to upload (if needed)Max. file size: 50 MB.CAPTCHA Δ Get an Instant Life Insurance Quote Need Life Insurance? Click Now FREE Get an Instant Auto Insurance Quote Need Auto Insurance? Click Now FREE Phone: (423) 292-4142