PAF Ins. Purl

(Personal Articles Floater Ins. Purl)

This PAF PURL is used to collect risk information for the purpose of quoting. Do not give or share with clients, in house use ONLY.

(Personal Articles Floater)

Agency Name*

enter agency prefix

Producer Names*

Assigned PURL*

How did you hear about us?*

Referred by:*

If known otherwise type Unknown

Notes:

For Edit Submission

Date*

Date

LOB*

Ezlynx Client:

Does the client already exist in ezlynx

What is the Ezlynx Client ID*

First Applicant:

First & Last Name*

as listed on driver license

Applicant Phone Number:*

Gather if not in client file already

Applicant Email Address:

Gather if not in client file already

Birthdate*

Date

Gender:*

Marital Status:*

Second Applicant:

First & Last Name *

as listed on driver license

Birthdate*

Date

Gender:*

What is the relationship to the first applicant:*

Applicant Address:

Physical Address (map it)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Address Type*

Mailing Address (map it) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Underwriting Questions:

Are we scheduling coins

YesNo

What is the value of the coins collection

Are we scheduling fine arts

YesNo

How many total pieces of art will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

5th - What is the value of the piece*

5th - Brief Description*

6th - What is the value of the piece*

6th - Brief Description*

7th - What is the value of the piece*

7th - Brief Description*

8th - What is the value of the piece*

8th - Brief Description*

9th - What is the value of the piece*

9th - Brief Description*

10th - What is the value of the piece*

10th - Brief Description*

11th - What is the value of the piece*

11th - Brief Description*

12th - What is the value of the piece*

12th - Brief Description*

13th - What is the value of the piece*

13th - Brief Description*

14th - What is the value of the piece*

14th - Brief Description*

15th - What is the value of the piece*

15th - Brief Description*

16th - What is the value of the piece*

16th - Brief Description*

Are we scheduling furs

YesNo

How many total pieces of fur will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

Are we scheduling guns

YesNo

How many total pieces of gun will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

5th - What is the value of the piece*

5th - Brief Description*

6th - What is the value of the piece*

6th - Brief Description*

7th - What is the value of the piece*

7th - Brief Description*

8th - What is the value of the piece*

8th - Brief Description*

9th - What is the value of the piece*

9th - Brief Description*

10th - What is the value of the piece*

10th - Brief Description*

11th - What is the value of the piece*

11th - Brief Description*

12th - What is the value of the piece*

12th - Brief Description*

13th - What is the value of the piece*

13th - Brief Description*

14th - What is the value of the piece*

14th - Brief Description*

15th - What is the value of the piece*

15th - Brief Description*

16th - What is the value of the piece*

16th - Brief Description*

Are we scheduling jewelry (in a vault)

YesNo

How many total pieces of jewelry (in a vault) will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

5th - What is the value of the piece*

5th - Brief Description*

6th - What is the value of the piece*

6th - Brief Description*

7th - What is the value of the piece*

7th - Brief Description*

8th - What is the value of the piece*

8th - Brief Description*

9th - What is the value of the piece*

9th - Brief Description*

10th - What is the value of the piece*

10th - Brief Description*

11th - What is the value of the piece*

11th - Brief Description*

12th - What is the value of the piece*

12th - Brief Description*

13th - What is the value of the piece*

13th - Brief Description*

14th - What is the value of the piece*

14th - Brief Description*

15th - What is the value of the piece*

15th - Brief Description*

16th - What is the value of the piece*

16th - Brief Description*

Are we scheduling jewelry (not vaulted)

YesNo

How many total pieces of jewelry (not vaulted) will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

5th - What is the value of the piece*

5th - Brief Description*

6th - What is the value of the piece*

6th - Brief Description*

7th - What is the value of the piece*

7th - Brief Description*

8th - What is the value of the piece*

8th - Brief Description*

9th - What is the value of the piece*

9th - Brief Description*

10th - What is the value of the piece*

10th - Brief Description*

11th - What is the value of the piece*

11th - Brief Description*

12th - What is the value of the piece*

12th - Brief Description*

13th - What is the value of the piece*

13th - Brief Description*

14th - What is the value of the piece*

14th - Brief Description*

15th - What is the value of the piece*

15th - Brief Description*

16th - What is the value of the piece*

16th - Brief Description*

Are we scheduling music

YesNo

How many total pieces of music equipment will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

Are we scheduling silverware

YesNo

How many total pieces of silverware will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

Are we scheduling other property

YesNo

How many total pieces of other property will be scheduled.

1st - What is the value of the piece*

1st - Brief Description*

2nd - What is the value of the piece*

2nd - Brief Description*

3rd - What is the value of the piece*

3rd - Brief Description*

4th - What is the value of the piece*

4th - Brief Description*

Attachments: (Optional)

Upload a File

Copy of prior policy or prior declarations, etc

Notes:

Help me find a Market nowNo - Not right now

Note: This will transfer the information from this form (Purl) to the matching CPA to help you shop all the carriers and determine the best options.