Personal – Fire Dwelling

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Personal - Fire Dwelling

Name of property owner*
Date of Birth
MM
DD
YYYY
Name of additional property owner
Additional property owner's date of birth
MM
DD
YYYY
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?*
- Asphalt
- Asphalt tile composite
- Clay tile
- Wood shingle
Flat roof?*
- Yes
- No
Number of stories*
Date property was purchased or projected closing date*
MM
DD
YYYY
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*
Phone
This field is for validation purposes and should be left unchanged.

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