Personal – Fire Dwelling – Frankel & Associates

Name of property owner*

Date of Birth

Name of additional property owner

Additional property owner's date of birth

Mailing address of name insured**

Street Address Address Line 2 City State ZIP Code

Address of location to be insured*

Street Address Address Line 2 City State ZIP Code

Date of plumbing upgrades*

Please provide a date or estimate of the last plumbing upgrade

Date of electrical upgrades*

Please provide a date or estimate of the last electrical upgrade

Date of wiring upgrades*

Please provide a date or estimate of the last wiring upgrades.

Date of roofing upgrades*

Please provide a date or estimate of the last roofing upgrade

Date of heating upgrades*

Please provide a date or estimate of the last heating upgrade.

What is the main source of heating?*

Construction type*

What material is the property built of?

Year built?*

Auxillary heating source?*

Yes
No

Is the property considered to be in "brush" territory?*

Yes
No

Number of units in property?*

Fireplaces?*

Yes
No

If so, how many?*

Number of total bedrooms?*

Number of bathrooms?*

What is the value of the personal property located within this residence?*

Roof type?*

Flat roof?*

Yes
No

Number of stories*

Date property was purchased or projected closing date*

Is the property occupied?*

Yes
No

Is the property within city limits?*

Yes
No

Is the property visible to neighbors?*

Yes
No

Does each unit have working smoke detectors installed?*

Yes
No

Do any of the units have window bars?*

Yes
No

If so, please provide description and email pictures.*

Do any dogs reside on the property?*

Yes
No

If so, what breeds?

Do the units have central station activated burglar alarms installed/activated?*

Yes
No

Current insurance company and reason for switching?*

Please provide full legal name, address, and loan number(s) for Loss Payee/Mortgage*

(800) 696-3023

service@frankelinsurance.com

Forms

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Personal - Fire Dwelling