Fact Finder E Version .pdf
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Original filename: Fact Finder E-Version.pdf
Title: MetLife Auto & Home® Fact Finder
Author: 2356
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Fact Finder
• For no-obligation quotes, please fill in as many fields as possible and fax this form to your agent.
• For accurate comparative quotes, include your current insurance policies’ “Declarations” pages in the fax.
Name __________________________________________ Email _________________________________________
Spouse/Civil Union Partner Name ____________________________________ Years at current address ________ County ___________________
Street Address ___________________________________ City _______________________________ State _________ Zip __________________
Home Phone ____________________ Cell Phone ___________________ I prefer to be contacted where/what time _______________________
Work Phone ____________________ Employer _____________________________________________ Years with current employer _________
Occupation _______________________ Full time or Part time __________
Auto Insurance
Current Auto Insurance Company ________________________________________ Policy # _________________________ Years with Carrier ___________
Current Premium___________________ Auto Policy Expiration Date _________________ Who owns the vehicles? ________________________________
Current Coverages
r25/50 r50/100 r100/300 r250/500
Permission to order reports? Yes / No
Current Collision Deductible
r250 r500 r1000
New Policy Start Date ________________________
Drivers in Household
Name
Date of Birth
Driver’s License Number
Gender
M/F
Marital
Status
Number
of Tickets
Number
of Claims
Age first
Licensed
All Vehicles in Household
Year
Make
Model
Primary Driver
Where parked at home (garage, Miles one way to
driveway, on street, etc.)
Work / School
Own/
Lease
Full Covg /
Liability
Alarm
Y/N
Homeowners Insurance
I want to insure a:
r Home
r Condo or Townhome ( r Center or r End Unit )
r Renters
r Other________________________________
Current Insurance Company_______________________________________________ Policy #__________________________ Years with Carrier____________
Current Premium___________________ Homeowners Policy Expiration Date________________ Who owns the home?_____________________________
Current Dwelling Amt__________________ Market Value________________
Liability
r 100K r 300K r 500K r 1M
Deductible
r 250 r 500 r 1000
# of Families__________
Do you Escrow?
Square Feet (above ground)___________________
Year Built___________
Style of Home_ _______________________________
Age of Roof__________________________________
dead bolts?
Exterior Type_ ________________________________
Age of Electrical_ _____________________________
fire extinguisher?
Number of baths: Full_________ Half_________
Age of Plumbing______________________________
smoke detectors?
Type of Heating_______________________________
Age of Heating_______________________________
central fire alarm?
Location of Oil Tank___________________________
Miles to Fire Department______________________
central burglar alarm?
Claim in the last 5 years_______________________
Number of Feet to Fire Hydrant________________
local burglar alarm?
Value of Contents (renters only)________________
Number of Fireplaces__________________________
trampoline?
r Yes r No
Do you have:
r Yes
r Yes
r Yes
r Yes
r Yes
r Yes
r Yes
r No
r No
r No
r No
r No
r No
r No
Value of “special” property such as jewelry, fine art, or expensive computer equipment_______________________ Any animals?_________________
Please Note Any Claims /Accidents / Special Instructions Here:

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