Personal Insurance Risk Analyzer


IS A PERSONAL RISK MANAGEMENT ASSESSMENT
PART OF YOUR FINANCIAL PLAN?

What are your risk factors? What protection do you need? To find out the answers to these questions, simply check "yes" or "no" next to the questions below to help point out the areas where you may face exposure. Once the form is submitted, it will be reviewed by a Kapnick Insurance Group personal insurance professional, who will then contact you to discuss risk management solutions.

Kapnick Insurance Group is a leading provider of personal risk management products and services for successful individuals like you. We recognize that no financial plan is complete without a comprehensive risk and insurance analysis. Your answers will be kept strictly confidential, and will help us put together a program of risk management and personal insurance solutions best suited to your unique individual needs.
   IDENTITY THEFT
   Do you or a family member use the internet for personal business?
   Does any third party have access to your personal information (accountant, attorney, banker, domestic employee, etc)? Yes    No
   Do you utilize up-to-date anti-virus and anti-spyware programs on all computers in your home? Yes    No
   Do you use social media? Yes    No
   Does your personal liability policy include coverage for identity theft? Yes    No
   Do you know the appropriate steps to take if you are a victim of identity theft?  Yes    No
   TRAVEL
   Do you or any family member travel outside of the United States? Yes    No
   Do you travel domestically or internationally more than three times per year? Yes    No
   Do you have medical evacuation coverage if you become injured or ill overseas? Yes    No
   Does someone reside at or check daily on your residence while you are traveling? Yes    No
   Is your home protected by a central station burglar alarm?   Yes    No
   PERSONAL LIABILITY
   Do you employ domestic staff such as a housekeeper or nanny?  Yes    No
   Do you serve as a director, officer or member of the board for a public, private and/or non-profit organization?   Yes    No
   Do you conduct business or entertain guests in your home?    Yes    No
  Do you make statements to the press?   Yes    No
   Do you know how much liability coverage you have?       Yes    No
   Have you updated your liability limits regularly to reflect your personal net worth? Yes    No
   PERSONAL SECURITY
   Do you have children? Yes    No
   If yes, are they over 25?   
   Do you worry about personal security risks such as home invasion, child abduction or carjacking?    Yes    No
   Do you have insurance coverage for personal security threats to you or your family?   
   PERSONAL RESIDENCE
   Has your residence been appraised for its insurance replacement value?    Yes    No
   Do you know the amount your insurer will pay for a total loss to your home?     Yes    No
   Do you have flood insurance for your residence?       Yes    No
   Do you own a secondary residence?   Yes    No
  Would you like to hear different dedcutible options?     Yes    No
   VALUABLE POSSESSIONS
   Do you know how your insurance would respond if your personal property is damaged or destroyed? Yes    No
   Do you collect jewelry, fine art, silver or other fine possessions?    Yes    No
   Do you have dedicated insurance coverage (a valuable articles policy) for the items you collect? Yes    No
   Do you maintain a thorough inventory of your valuable possessions?       Yes    No
   PERSONAL RISK MANAGEMENT
   Do you review your insurance coverage with your agent on an annual basis? Yes    No
   Do you currently work with a captive agent or broker such as State Farm or Allstate  (vs, an independent broker)? Yes    No
   ADDITIONAL COMMENTS
  CONTACT INFORMATION

   Name:    Phone:  

    Email: