HOME-BASED BUSINESS QUESTIONNAIRE

(July 2020)

With the availability of either standard or proprietary stand-alone policies or endorsements, the applicable form should be considered a primary source for gathering the information necessary to insure a home-based business exposure.

However, this article is offered as another source for identifying possible coverage needs and may be useful as a supplement.

Client/Applicant Name ___________________________________________

Is the business at the primary residence operated on a full-time basis? ___ Yes ___ No

Are there other separate business locations? ___Yes ___No

Business name: ________________________________________

Describe the business.

____________________________________________________________________________________

What is the form of ownership?

___ Proprietorship ___ Partnership ___ Joint Venture ___ Limited Liability Corporation ___ Other

Describe other:

____________________________________________________________________________________

______________________________________________________________________________

List the household member(s) who own the business:

Name	Age	% Owned

Do individuals who do not reside on the premises own any part of the business? ___ Yes ___ No

If yes, identify them and describe their relationship to the other owners and how they are involved with the business.

Name	Relationship	Involvement

List household members(s) the business employs.

Name	Age

Does the business employ individuals other than household members?

If yes, describe their relationship to the owners and the job(s) they perform.

Name	Relationship	Job(s) performed

When did the business begin? _____

If the applicant sells products, what are the gross annual sales? $____________

If the applicant provides services, what are the gross annual receipts? $_____________

What is the business personal property’s actual cash value? $______________

Describe the business personal property.

____________________________________________________________________________________

What is the maximum actual cash value of property of others on the premises? $_______________

Describe the property of others that could be on the premises.

____________________________________________________________________________________

What is the square foot area of the business operation? ____________________

If the business is retail (other than crafts and food), answer the following:

Is the product distributed under the applicant’s own private label? ___Yes ___No

The inventory is stored in (check all that apply):

___ Residence	___ Attached garage
___ Other structure(s) on premises	___ Other structure(s) off premises

The customer receives the product by:

___ Mail/UPS	___ Customer pickup	___ Owner delivery
___ Contract delivery	___ Other

Describe other:

_____________________________________________________________________________

Does the applicant sell the product at fairs, flea markets, or similar events? ___Yes ___ No

Do customers come to the applicant’s residence to purchase the product? ___Yes ___ No

If the business is service, answer the following:

Does the work involve: ___Installation ___ Consultation ___ Instruction?

Does the applicant travel to jobsites? ___ Yes ___ No

If yes, describe the vehicles used.

Unit Number	Vehicle description

Does the applicant have a professional liability exposure? ___Yes ___No

If the business is crafts, answer the following:

Does the applicant sell the product at fairs, flea markets, or similar events? ___Yes ___ No

The customer receives the product by:

___ Mail/UPS	___ Customer pickup	___ Owner delivery
___ Contract delivery	___ Other

Describe other:

_____________________________________________________________________________

If the business is food-related, answer the following:

Is food prepared on the premises? ___Yes ___ No

Is food prepared under a private label? ___ Yes ___No

Is food served off premises? ___Yes ___No

Does the applicant provide delivery service? ___ Yes ___ No

If yes, describe the vehicles used.

Unit Number	Vehicle description

If the business is an office, answer the following:

Is the applicant a telecommuter for another business? ___Yes ___No

Does the applicant have a professional liability exposure? ___Yes ___No

Does the applicant have access to confidential information? ___ Yes ___ No

Do clients come to the residence to conduct business? ___ Yes ___No

Does the business involve use of Additive Manufacturing (3D Printing)? ___Yes ___No

If yes, please provide details on the types of items manufactured.

_____________________________________________________________________________

_____________________________________________________________________________

Is Additive Manufacturing done in full compliance of copyright laws? ___Yes ___No