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Homeowners Insurance (SFR):

Full Name (s) to be on the policy:

Address of the property

Mailing Address (current for the Owner)

Contact Name, Phone # and E-mail:

First Name

Last Name

Phone Number

Is property Owner Occupied?

Yr. Built:

Type of Roof:

How many families?

Construction Type:

Square footage:

Is property currently Insured (for Refi and/or Expiration only)?

If yes, please provide Copy of Current Declaration page and or current limits of Dwelling Coverage (coverage A) (for Refi and/or Expiration only):

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Any claims in the past 5 yrs.?

If yes, please provide details (for Refi and/or Expiration only)

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Has the property been updated in the last 25 yrs:

Roof – year of update:

Plumbing – year of update:

Electrical – year of update:

Heating – year of update:

***This is crucial information that is necessary for all properties if available this isa botleneck and may result in declination and/or increased rate. ***(Insurancecompany runs building permit reports and if they don’t find any on file, they will be looking for receipts and statements from contractor that may have done any updates that did not require permits and full description of work done)

Circuit Brakers or Fuses or both?

Copper Plumbing or Galvanized?

Is there a Swimming Pool?

Is it fenced with 6ft high fence?

Is there a trampoline?

Are there any pets?

Please indicate what kind and breed:

Is there a Central Station Fire and Theft Alarm (Security system discount available):

*** All quotes will be provided with $500k in Liability Limits and $5k Medical Payments Limits. All Quotes will be subject to change if information provided will change in a course of inspection and/or claims report. *** Please use N/A for anything that does not apply to this property. *** Additional Questions may be requested by Underwriting to confirm the rate.

*** All quotes will be provided with $500k in Liability Limits and $5k Medical Payments Limits. All Quotes will be subject to change if information provided will change in a course of inspection and/or claims report.
*** Please use N/A for anything that does not apply to this property.
*** Additional Questions may be requested by Underwriting to confirm the rate.