Property Questionnaire
CLIENT INFORMATION
Name
DOB
Phone
E-mail
How did you hear about UIP?
Completed by:
Assigned To:
Tenant or Owner Occupied
Tenant
Owner
Condo
If Tenant occupied, how many units
PROPERTY DETAILS
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Property was purchased
Year built
Square Footage
Single or multiple story home
What type of roof does your home have?
Number of bathrooms
Have you filed any claims in the past 10 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 or a built in 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?
Solar Panels (are they leased or owned?
Full Name
First Name
Last Name
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