Life Changes Simple Survey

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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

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you had any family changes?(Required)

E.g. new child, marriage, divorce, death of spouse, child moving out

Yes

Has there been a change in the number of drivers living in the house?(Required)

Yes

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

Do you own a business?(Required)

Yes

What type of business do you own?(Required)

Is your business in-home?(Required)

Yes

Have you earned a degree or certification since your last renewal?(Required)

Yes

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

Tell us about any changes in driving habits(Required)

Have you or do you plan to do any home improvements?(Required)

Yes

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

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

I already have an umbrella policy

Would you like a quote for identity theft/fraud protection?(Required)

Yes

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

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

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

Additional items to insure (that Veritas does not already insure)?(Required)

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.

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Phone: (423) 292-4142

What Our Clients are Saying

It was everything I was looking for and needed. The service was great and affordable. I could not have asked for more.

Ethan E.

Megan and Andrew have been very helpful and responsive. They have answered all my questions in a timely manner and guided me through the process of applying for Medicare supplement and drug plans. I would highly recommend Veritas Risk Management!

Terri G.

I love Veritas and ALL their employees. Everytime I have ever called. Everyone is so cheerful when they answer the phones. They always tend to my needs and answer all my questions. Tammy Collins is THE BEST! She is so friendly, so helpful and so kind. She has always went the extra mile to help our family with our insurance needs. Thank you all very much! I highly recommend your company and employees. God bless you all.

Lynda & Floyd Scalf

Very helpful, knowledgeable about their own products and services and those of other providers, truthful, willing to spend the time it takes to get the issue addressed, were able to address my needs versus selling me something that really didn't fit my needs

Victory C.

The agent I dealt with was very professional, knowledgeable and efficient. She made me feel that I was important and my business was valued.

Michael M.

Tammy Collins was amazing! She was so very helpful, patient, and responsive. We were nervous about going through a “broker” for our insurance needs but she eased our minds. It was a pleasure speaking with her!

Angie L.

Being proactive in reaching out when you think I might have a need, and notifying me of discounts if I put all my insurances there, like my cars.

Jake H.

Terri G.