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  • Required Document for All New Business HO and DP Policies (Not designed for builder's risk or vacancy)

  • Basic Information

  • Applicant DOB?*
     / /
  • Is there a co-applicant?*
  • Co-Applicant DOB?*
     / /
  • Will the property be owned by a corporation?*
  • Format: (000) 000-0000.

  • Determining Policy Form

    Questions Used to Determine Policy Needed
  • What will be the purpose of this property?*
  • What is the construction of the property?
  • How many months a year do you reside at this property?*
  • Do you require at least an annual lease?*
  • Do you allow any form of short term rental?*
  • What is the home type?*
  • How is Mobile Home Situated?*
  • Are you responsible for the exterior of the property and the roof?*

  • Discount Questions!

    The best part of the form!
  • Do you have a wind mitigation form?*
  • Alarms in the home?*
  • Community Access Discount?

  • Underwriting Questions

    These are some of the most common underwriting related questions that arise that can affect eligibility
  • Is there any existing damage or debris on the property?*
  • Has coverage on this property been cancelled, rejected, or non-renewed in the last three years?*
  • Will the property be occupied within 30 days of effective date?*
  • Do you own any animals?*
  • Pool on the property?*
  • Pool Area Screened? OR Yard Entirely Fenced?*
  • Are there currently any type of renovations or construction occurring on the property?*
  • Was the home purchased through short-sale or foreclosure?*
  • Does your home have any burglar bars installed?*
  • Do the bars have quick release mechanisms?*

  • Loss History

  • Has this property or any properties you've owned sustained in damage that resulted in a claim in the past 5 years?*

  • Update Questions

    Questions used to determine age of major systems in home for discount and eligibility purposes.
  • Are you aware of the presence of Polyethylene in your home?*
  • To your knowledge is your electrical panel made by Federal Pacific or Sylvania?*
  • To your knowledge does your home contain any aluminum, cloth, or knob and tube wiring?*

  • Document Upload

    Upload these documents optionally to improve your quote.
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  • Please retain this completed on the applicants file. If the applicant purchases a policy, this document is required to be sent for signature alongside their applicant and should be saved on the file after signature is obtained.

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