LSIG - Renters Punch List

Full Name

1. Address of Property

2. Mailing Address

3. Email Address

example@example.com

4. Phone Number

Format: (000) 000-0000.

5. SSN

6. Date of Birth

Date

7. Marital Status

8. Tx DL Number

9.Residence Type:

10.Are there any ineligible dog breeds on the premises?

Properties where animals with dangerous propensities or which present unusual liability exposures are kept are ineligible for coverage. This includes, but is not limited to, Akitas, American Bulldogs, Chow-Chow, Doberman Pinschers, Mastiffs, Pit Bulls, Rottweilers, Staffordshire Terriers, Wolf Hybrids, or any mix or variation of these breeds, any dog with a history of biting, or any dog underwriting deems ineligible. Properties with exotic, farm, saddle, or hooved animals are ineligible for coverage.

12.Is this located in a secured subdivision

11.Personal Property desired coverage limit:

Some Carriers will not cover less than $15,000