HABITATIONAL INSURANCE APPLICATION  ( Personal information )

Applicants Full Name and Address:     ……………………………………………….                                                                              

………………………………………………………………………………………..

Telephone:……………….                                           Cell …………………………...

Date Of Birth…………….                                           Occupation ……………………

Previous Insurance  Company  …………………      Policy # ……………

Exp. Date  ………………….                                     Any Claims last 5 years ………

HABITATIONAL INSURANCE APPLICATION  ( Property Information )

House …..   Rented House …..  Condo ……. Rented Condo ………  Tenant ………

Age Building …… 

We require more info for house insurance like Roof type, age and Electrical , Plumbing

Etc.    ……………………………………………………………………………………

Condo Insurance : coverage for content, Liability & Water damage & Earth Quake  

Rented Condo Coverage: Liability, water Damage & rental  Income +content +E/Q

Tenant Coverage : Liability, Content ( Min. $35,000) Water/Damage