Personal Insurance Renewal Update Step 1 of 5 20% Name(Required) First Last Email(Required) Phone Number(Required) Please check all situations that apply to you.(Required) Address Change Birth of a child Career Change Marital Status Change Started A Business No Changes Address ChangedDate Moved? Updated Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Career ChangeCongrats on the new career! What is your new job title? Marital Status ChangeWhat is your current marital status? Married Divorced Widowed Spouse Name Started a BusinessWhat is the name of your new business? What is the industry of your new business? Please check all that apply to you regarding your auto policy.(Required) Driver Added Driver Removed Vehicle Bought Vehicle Sold No Changes I do not currently have an auto policy with Platt Insurance New Driver InformationAdd Driver To Policy First Last Birthday Relation DL # Car Driven Annual Miles Driver Being RemovedRemove Driver From Policy First Last Reason Why New Vehicle InformationDate Purchased MM slash DD slash YYYY Year/Make/Model of purchased vehicle(s) Add RemoveClick the + to add rows for additional vehicles.Vehicle Being RemovedDate Sold MM slash DD slash YYYY Year/Make/Model of sold vehicle(s) Add RemoveClickAdditional QuestionsAre you driving for a rideshare or delivery company? Yes No If yes what company? Have you started using your vehicle for business? Yes No (Roofing, real estate, advertisement, etc.)What Business? Please check all the apply to you regarding your home policy.(Required) Home Renovations/Improvements Roof Replaced Sold Home Purchased New Home No Changes I do not currently have a home policy with Platt Insurance. Home Renovations/Improvementsi.e. Roof Replacement, Furnace Replacement, HVAC Updates etc.Please list the renovations and an approximate cost of each. Add RemoveYou can use the + button on the right side to add additional rows.Sold HomeDate Sold MM slash DD slash YYYY Purchased New HomeDate Purchased MM slash DD slash YYYY Does your new address match the one you listed in the Updated Address field? Yes No If no, what is the new address? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Have you recently purchased any of the following?(Required) ATV Boat Golf Cart Motorcycle Slingshot Ebike Rental Home/Investment Property Second Home/Vacation Home No New Purchases ATV PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Boat PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Golf Cart PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Motorcycle PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Slingshot PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Ebike PurchaseYear, Make and Model Date Purchased MM slash DD slash YYYY Value Rental Home/Investment PropertyProperty Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is the property currently insured? Yes No Who insures the property? Secondary Home/Vacation HomeProperty 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 Is the property currently insured? Yes No Who insures the property? Are there any additional changes that we should know about prior to your insurance renewal?Would you like us to reach out to you closer to your renewal to review your policies further? Yes, please reach out to me. No, I do not need to review at this time. PhoneThis field is for validation purposes and should be left unchanged.
