About this template
An Insurance Application Form is essential for insurance agencies, brokers, and carriers looking to collect comprehensive applicant data efficiently. This template captures vital personal details, employment information, desired coverage amounts, beneficiary designations, and relevant medical history in a single, structured workflow. By streamlining data collection, underwriters and agents can review submissions faster and make more informed policy decisions.
Doc2Form makes it simple to deploy this insurance application as a Google Form, allowing applicants to apply seamlessly from any device. Securely gather policy requests, emergency contact details, and income disclosures without messy paperwork. Once submitted, all responses flow directly into your Google Workspace, making it easy to sort applications, calculate risk, and follow up with prospective policyholders.
Key features
- Collect complete applicant and beneficiary information instantly
- Capture exact coverage amounts and policy preferences
- Gather necessary medical history and lifestyle risk factors
- Manage and organize all policy submissions directly in Google Sheets
- Fully customizable to match specific agency or provider requirements
Use cases
- New life or health insurance policy applications
- Client intake for independent insurance agencies
- Gathering initial quote details before formal underwriting
- Updating beneficiary and coverage details for existing clients
What this form collects
- Full Name (Short answer)Enter your first, middle, and last name as it appears on your government-issued ID.
- Email Address (Short answer)We will use this email to send your policy updates and quote documents.
- Phone Number (Short answer)Include your area code (e.g., 555-0198).
- Date of Birth (Date)Used to determine age-based premium rates.
- Residential Address (Paragraph)Provide your current street address, city, state, and ZIP code.
- Occupation (Short answer)Enter your current job title.
- Employer's Name (Short answer)Name of the company or organization you currently work for.
- Annual Income ($) (Short answer)Enter your approximate annual pre-tax income.
- Type of Insurance (Dropdown)Select the primary coverage type you are applying for.
- Insurance Coverage Amount ($) (Short answer)Specify the total benefit or coverage amount you are requesting.
- Length of Coverage (Multiple choice)Indicate your desired policy term or duration.
- Beneficiary's Full Name (Short answer)Name of the primary individual designated to receive policy benefits.
- Relationship to Applicant (Short answer)How the beneficiary is related to you (e.g., Spouse, Child, Sibling).
- Emergency Contact Name (Short answer)Name of someone who can be reached in case of an emergency.
- Emergency Contact Number (Short answer)Phone number for your emergency contact.
- Medical Conditions (Paragraph)List any pre-existing medical conditions, past surgeries, or ongoing treatments.
- Medication List (Paragraph)List any prescription medications you currently take on a regular basis.
FAQ
How do I customize this insurance application template?
Once you convert or open the template in Google Forms, you can easily add, remove, or modify questions to match your specific lines of coverage, state regulations, or underwriting guidelines.
Can I collect file attachments like medical records or IDs?
While Google Forms handles standard data collection, you can include text fields for applicants to paste secure links to documents stored in Google Drive or Dropbox.
Where does the application data go when submitted?
All form responses are saved securely in your Google account and can be automatically linked to a Google Sheet for easy review by your underwriting and sales teams.
Is this template suitable for all types of insurance?
It provides a comprehensive foundation for life, health, and personal lines of insurance, and can be easily adapted for commercial or specialty policies.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.