Property Questionnaire

CLIENT INFORMATION

Name

Phone

E-mail

How did you hear about UIP?

Completed by:

Assigned To:

PROPERTY DETAILS

Property Address

Is your property owner or tenant occupied?

Year built

Square Footage

Single or multiple story home

Have you filed any claims in the past 3 years?

Type of foundation (Slab, Raised, etc.)

Floor finishes (%wood, %carpet, %vinyl, % ceramic)

What type of electrical wiring does your home have?

Type of pluming and year when you last serviced it?

Do you have an attached or detached garage?

How many fireplaces are in the home?

Do you have central heating and air conditioning?

Do you have a fire and/or burglary alarm system?

UNDERWRITING QUESTIONS

Do you own any pets? (dogs, cats, etc.)

Is there a pool or a spa on the premises?

Do you have a slide or a diving board?

Is there a trampoline on the premises?

How many miles are you from the nearest fire station?

How many feet is your home from the nearest hydrant?

Are there metal/security bars on your windows?

Do you have any scheduled fine art, jewelry, collectibles?

Do you conduct business form your home?

Full Name

First Name Last Name