Homeowners

Homeowners Insurance Form Template
Name

First NameLast Name
Date of birth

MonthDayYear
DOB
What’s your home address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you rent or own it?

RentOwn
Year purchased

MonthDayYear
Date
Are you closing on a new home or just thinking of switching insurers?

I’m closing on a new homeI’m thinking of switchingOther
What type of property is it?

Detached HomeSemi-attachedTownhouseCondoCo-opMulti-unit
What type of building is it?

Single familyDuplexTriplex/Fourplex
Number of stories
What is the square footage of your home?
Square Footage
Total square footage of outside porch/deck area
Square Footage
Who lives in your home?

It’s just myselfWe’re a coupleCouple with childrenMy children and IOther
How would you describe the condition of the Exterior & Interior?

Needs workStandardHighSuperb
Type of construction
Type of siding
When was your house built?
How do you heat your home?

GasOilOther
Where is the tank located?

Above groundUnder ground
Age of boiler
What breed is/are the dog(s)?
Did your home undergo any substantial renovations? If so, when?
*Leave blank if no renovations or unknown
Please describe the type of work that was done
Details about renovations
Do you have any of the following?

Fire alarmBurglar alarm
If you’d like, we can match our coverage to your existing policy.

Sure, let’s do itNo need
Do you want to upload your current policy information or enter it manually?

Upload files, pics, etc...Enter information manually
Upload a copy of your existing policy so we may review and compare

Cancelof
Did you file any home or property claim within the past 5 years?

NopeOnly oneMore than one
Should be Empty:

Homeowners Insurance Form Template