Private Client Intake — Maverick Insurance Brokers
Maverick Insurance Brokers Private Client Group

Welcome to Maverick

Tell me a little about yourself.

Before our call, I'd like to understand your situation. This takes about three minutes and helps me come prepared — so our conversation is focused, relevant, and worth your time. Everything you share is confidential.

Section 1 of 8
Section 01 of 08

Personal Information

Let's start with the basics. This information is kept strictly confidential and used only to build your client file.

Preferred Contact Method
Best Time to Reach You
Section 02 of 08

Your Household

Tell us about who lives with you. This helps us ensure every member of your household is properly considered within your protection plan.

Marital Status
Spouse / Partner Details
Dependants
Other Household Members
e.g. adult children, live-in staff, parents
Private Household Staff
Section 03 of 08

Your Properties

List your primary residence and any additional properties. Accurate rebuild values and property details help us ensure there are no gaps in your coverage.

Primary Residence
Additional Properties

Please list any additional properties you own — cottages, investment properties, rental units, vacation homes, or properties abroad.

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Your Vehicles

List all vehicles in your household, including classic, collector, or seasonal vehicles. Include all drivers who operate them.

Vehicle 1
Additional Vehicles & Recreational
Section 05 of 08

Your Assets & Lifestyle

Standard home policies often fall short when it comes to high-value assets and lifestyle-specific risks. Please indicate anything that applies to your household.

Valuables & Collections
Watercraft & Recreation
Travel
Home & Lifestyle
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Your Current Coverage

Understanding where you are now helps us identify exactly what needs to change — and what's working well.

Lines of Coverage Currently in Place
Your Current Broker Relationship
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Your Goals & Priorities

This is the most important section. Your answers here shape everything about how Bram approaches your file. Please take a moment to be as candid as you like.

e.g. responsiveness, expertise, access to your broker, value, comprehensive coverage
What are your primary goals in reviewing your coverage?
Section 08 of 08

Almost done

Last couple of things before we wrap up.

What happens next

Bram will personally review your submission and reach out ahead of your meeting. Come prepared to have a real conversation — no scripts, no sales pitch, just an honest look at your situation.

By submitting, I agree to receive occasional updates and insights from Maverick Insurance Brokers. You can unsubscribe at any time.

Maverick Insurance Brokers

You're in good hands.

Your intake form has been received.

Bram Bains will personally review your submission and be in touch within one business day.

In the meantime, feel free to explore Maverick's Private Client Group resources.

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