Type of Residence:
(If non-owner
occupied/rental must complete Dwelling Fire
Questionnaire) |
Construction:
|
| Living Area Square
Footage: |
Built on: |
| Do You Have a Carport or
Garage: |
Number of
Families: |
| One, Two, or Three
Car: |
Is it Attached: |
| Do You Have Any
Porches: |
Open or Enclosed: |
| What Are The Measurements
of Porches (Width X Length): |
|
| Do You Have a
Fireplace: |
Wood Burning Stove:
|
| What Type of
Heating do You Have: |
|
| What Type of A/C do you
have: |
|
| How Many Full
Baths: |
How Many
Half Baths: |
| Do You Have a Swimming
Pool: |
Is it Fenced: |
| Do You or Your
Tenants Have Any Pets: |
If so, Breed: |
| When Was House
Last Painted: |
Roof
Replaced: |
| If Dwelling is
over 25 Years Old, Give Dates When Updated: |
Wiring:
Heating:
Plumbing:
|
| Do You Have
Fuses, Circuit Breakers or Both: |
|
| Do You Have A
Burglar or Fire Alarm: |
|
| Is it a Local
or Central Station Alarm: |
|
| Do You Have
Smoke Alarms: |
Dead Bolt Locks: |
| Fire
Extinguishers: |
|
| How Long Have
You Lived at This Address: |
|
| Value Desired
on Home: |
Deductible: |
| Any Losses in
Last Five Years: |
|
| Present
Homeowner Insurance Carrier: |
|
| Any Credit
Problems in the Last 10 Years: |
|
| Any Business
Conducted on Premises |
|
| Your
Occupation: |
|
| Spouse
Occupation: |
|
| Your Age: |
|
| Spouse's Age: |
|
| Do you have a
child away at school with a computer? |
|
| Do you have any
other dwellings to be insured? |
|
| Do You Need
Flood Insurance: |
|
|
Consumer reports may be
ordered as part of the underwriting process.
|
