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Insurance Policy Information Worksheet
Insurance Policy Information
Auto Insurance Policies
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Vehicle 1 |
Vehicle 2 |
Vehicle 3 |
Vehicle 4 |
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Year & make
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Vehicle ID # |
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Bodily injury
coverage |
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Property damage
coverage |
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Uninsured motorist
coverage |
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Collision deductible |
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Comprehensive
deductible |
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Other information |
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Annual premium |
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Policy number |
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Insurance company _________________________________________
Insurance agent ____________________________________________
Agent
phone number ________________________________________
Life Insurance Policies
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Person A |
Person B |
Person C |
Person D |
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Name |
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Benefit amount |
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Beneficiary |
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Policy type (term,
whole, etc) |
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Annual premium |
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Policy number |
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Location of policy |
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Any loans taken |
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Insurance company |
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Insurance agent |
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Insurance phone
number |
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Employer provided? |
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Other Insurance Policies
Homeowner’s/Renter’s Policies
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Policy 1 |
Policy 2 |
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Address covered |
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Insurance company |
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Policy number |
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Insurance agent |
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Agent phone number |
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Coverage amount –
structure |
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Coverage amount –
contents |
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Deductibles |
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Riders |
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Annual premium |
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Location of policy |
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Umbrella Liability Policy
Insurance company
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Insurance agent |
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Agent phone number |
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Policy number |
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Coverage amount |
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Location of policy |
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Health Insurance Policies
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Policy 1 |
Policy 2 |
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Family members
covered |
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Insurance company |
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Insurance agent |
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Agent phone number |
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Policy number |
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Annual premium |
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Deductibles |
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Co-pays |
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Prescription
coverage |
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Dental coverage |
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Eye care coverage |
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Riders or exclusions |
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Employer provided? |
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Click here to download PDF file
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Equal Housing Lender.