Policy Type: |
Condo Homeowners Rented Condo Rented Dwelling Tenants
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First Name: |
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Last Name: |
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Phone No.: |
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Email: |
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Property Address: |
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Postal Code: |
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Effective Date: |
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Named Insureds: |
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Date of Birth (mo/d/yr): |
 |
Any Claims in the past 5 years?: |
Yes No
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How many years have you carried insurance?: |
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Is there a secondary suite?: |
Yes No
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Is there a mortgage: |
Yes No
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Year Built: |
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Roof Type: |
Asphalt Shingle Clay Shingle Metal Clad Other Wood Shingle
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Plumbing Type: |
Copper/ABS PEX
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Heating Type: |
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Electrical Service: |
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Exterior Finishing: |
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Number of Stories: |
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Number of Bathrooms: |
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Square Footage: |
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Any wood heating appliances: |
Yes No
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Does the house have any porches or decks?: |
No Yes
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If yes describe by size and type (wood) (covered?): |
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Monitored Alarm System: |
Yes No
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Is there a basement?: |
Yes No
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Basement Total Sq Ft: |
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Basement Percent Finished: |
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Is there a garage?: |
No Yes
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Size: |
One Car Two Car Three Car Other
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Type: |
Attached Carport Detached
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