Sonali Insurance Agency Inc.
* Marked questions are required. If you filled out name, address, DOB & email in the previous page or don't know the answer to other question(s), you can skip. For better quote, please add your social security number. Thank you.
Name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insured Date of Birth
-
Month
-
Day
Year
Date
Insured SSN/ FEIN
Spouses Name if Joint Insured
Spouse Date of Birth
-
Month
-
Day
Year
Date
Property Address to be Insured ( If different than current address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner/ Tenant
*
Owner Occupied Only
Owner/ Tenant Both
Tenant Only
Primary or Secondary Residence:
*
Primary
Secondary
Other
Alarm System
Professionally Monitored (Monthly Pay)
Local (App Notification)
None
Other
Heating/ Hot Water Type
Oil
Natural Gas
Propane Gas
Other
Did you file any claims? If so describe.
Do You Have Any Dogs/Other Pets?
Any Pool in the Property?
*
Yes
No
Any Trampoline in the Property?
*
Yes
No
How Did You Hear About Us?
Upload Current Insurance Declaration Page, Or Take a Picture Below
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Take a Photo of Current Insurance Declaration Page
Comment(s)
Submit
Should be Empty: