Renewal Questionnaire - Car Insurance

Policy Information
Policyholder Name*
Email Address*
Primary Phone Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What year did you move to this address?*
Personal Information Consent*
- Yes, I Consent
I, on behalf of myself and all other policyholders and drivers listed, authorize Cheep Insurance and/or its insurance company suppliers to collect, use and disclose information or reports relevant to my personal insurance rating, policy placement and payment thereof. I understand that as an insurance broker, Cheep Insurance is gathering this consent on behalf of multiple insurance companies for the purpose of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or changes and preventing fraud. I authorize collection, use and disclosure of relevant personal insurance reports including policy and claims history of up to 25 years, investigative, rating and risk information as permitted by law and in accordance with privacy policies. I understand that this consent is required to add a driver to my policy, therefore I am unable to proceed with the request without providing this consent.
Updates to Vehicles, Drivers & Use
Have there been any changes to the vehicles listed on your policy?*
Have there been any changes to the use of the vehicles (ex: annual km driven, commute distance, etc.)?*
What is your occupation?*
Have there been any changes to the drivers listed on your policy?*
Additional Discount Information
Does your vehicle have snow tires?*
- Yes
- No
Does your residence have private parking?*
- Yes
- No
A discount could be available for all private passenger vehicles with a private space for parking, such as a private garage, driveway, or carport.
Do you consent to a soft credit check to determine if you’re eligible for a credit-based discount (up to 30% savings)?*
- Yes
- No
Some of the insurance companies we work with are now offering discounts based on soft credit check results. This does not impact your credit score, and we don't see your credit information, the system just determines the discounts available.
Would you like us to include usage-based driving (telematics) options when we compare quotes for you (up to 30% savings)?
- Yes
- No
Some companies offer discounts based on your driving habits through “telematics programs”. If you enrol in one of these programs, you get a 10-15% discount on your car insurance for the first 6 months to a year, you install a device in your car to monitor your driving habits, and you can receive additional discounts based on those habits.
Credit Consent Statement*
- Yes, I Consent
I authorize Cheep Insurance and/or its insurance company suppliers, on behalf of myself and other policyholders listed, to collect, use and disclose information or reports relevant to my personal insurance rating, policy placement and payment thereof. I understand that as an insurance broker, Cheep Insurance is gathering this consent on behalf of multiple insurance companies for the purpose of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or changes and preventing fraud. I authorize collection, use and disclosure of relevant personal insurance reports including policy and claims history of up to 25 years, investigative, rating and risk information and personal credit information, as permitted by law and in accordance with privacy policies.
Comments
Do you have any other comments to make for this change?

Renewal Questionnaire - Car Insurance

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