CURRENT INSURANCE INFORMATION
Is your condo currently insured?
Expiration Date:
Policy Number:
POLICY HOLDER INFORMATION
Name:
DOB:
Home Phone:
Spouses Name:
Work Phone:
Address:
Cell Phone:
Email:
Property Address:
Name of Association:
Year Built:
Are you the original owner?
Yes No
Fire Dept Servicing?
Within 1000 Ft. of a Hydrant?
COVERAGES
Dwelling Amount:
Contents Amount:
Loss Assessment Coverage:
Liability Limit:
Deductible:
Has your current agent reviewed your association bi-laws and made coverage recommendations? Yes No
Would you like us to review the bi-laws and the master deed for you? Yes No
UNDERWRITING QUESTIONS
Smoker:
If yes, What Type?
Dogs?
Breed
Hot Tub?
Locking Cover? Yes No
Trampoline?
DESCRIBE ALL CLAIMS IN THE PAST THREE YEARS:
Type
Year
Make
Model
Serial#/Vin#
CC
Value
Hull ID#
I/B or O/B
Horsepower
Length
N/A Inboard Outboard
JEWELRY OR VALUABLES TO BE SCHEDULED
Description
HOME FEATURES
Sq. FT- Ground Floor
Sq. FT. - Finished Basement:
Type of Construction
Substructure:
Walk-Out Basement?
Fireplace: Yes No
# of Full Baths:
# of 1/2 Baths:
Central Air:
Garage Type?
Attached Unattached None
# of Stalls:
Room Additions Above Garage?
:
Any Outbuildings?
Have you made any alterations improvements to the property?
Enter Security Code:
