West Palm beach car accident Bad Faith client, Insurance Bad Faith
Cases

Client Interview Questionnaire

1. Name

2. Address

3. Telephone number

4. Date of birth

5. Social security number

6. Driver's license number

7. Spouse's name

8. Spouse's date of birth
9. Spouse's social security number

10. Children's name(s)

11. Ages

12. Purchase price of home

13. Approximate current value of home

14. Automobiles (makes, models, years, purchase price, approximate
present value)

15. Boats (makes, models, years, purchase price, approximate
present value)

16. Airplanes (makes, models, years, purchase price, approximate
present value)

17. Identify by company name and Florida Car Accident Policy Number
(including any riders) each of the following insurance policies which
you have held at any time since a date two years prior to the
accident
to the present:

HOME

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

AUTOMOBILE

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

GENERAL LIABILITY

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

0.75in 0pt 0in;">

AIRPLANE

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

UMBRELLA/EXCESS LIABILITY POLICIES

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

PROFESSIONAL PRACTICE/LIABILITY POLICIES

Company Name Florida Car Accident Policy Number

__________________ ________________

__________________ ________________

__________________ ________________

__________________ ________________

ANY OTHER POLICIES

Company Name