What is your first name? *
What is your last name? *
What is your preferred phone number? *
What is your email address? *
What is your occupation?
What is the name of your employer?
What is your date of birth? *
MM slash DD slash YYYY
What is your marital status?
What is your spouse's full name?
What is your partner's full name?
What is your fiancé's full name?
Please enter their occupation and employer name:
Please enter their date of birth.
MM slash DD slash YYYY
Please enter the address of the condo/co-op you would like a proposal for (Include apartment number, if applicable). *
Is this a Condominium or Cooperative?
What type of property is this?
Are you in the process of purchasing this condo/co-op?
What is the purchase price?
What is the closing date?
MM slash DD slash YYYY
What is the name of your current insurance company?
When would you like coverage to start?
MM slash DD slash YYYY
Please select the intended occupancy of the condo/co-op you are purchasing.
Please describe the intended occupancy of the home you are purchasing.
Please select the occupancy of this property.
What is the occupancy of this condominium/cooperative?
Please select the months this unit will be occupied. (Select all that apply)
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What is your current home address?
What is your primary home address?
Have you lived at your current address for three or more years?
Have you lived at your primary home address for three or more years?
Please provide the address where you lived prior to your current address?
Please provide the address where you lived prior to your current address?
Will you renovate this condo/co-op before moving in?
What is the renovation budget?
How long will the renovation take?
Please provide a brief description of your renovation plans.
Please select the frequency of rentals for this Condo/Co-op.
Will there be a mortgage?
What is the name of the bank providing the mortgage?
Who is your contact at the bank?
What is the phone number for your contact at the bank?
What is the email address for your contact at the bank?
Is there a mortgage?
Please enter the bank name, if convenient. (Ex. Bank of America NA, ISAOA ATIMA)
Please enter the bank address, if convenient.
Please enter the loan number, if convenient.
Is there a Trust, LLC, Limited Partnership or other legal entity involved in the ownership of this property?
Legal Entity Information
What is the name of the legal entity?
What type of legal entity is it?
Please enter the type of legal entity:
Is the mailing address for the legal entity the same as the location address for this proposal?
What is the mailing address for the legal entity?
Please provide a description of the asset(s) owned by this entity. (Address, personal property, etc...)
Please provide the principal/beneficial owner(s)/trustee name(s) and their relationship to you.
What is the purpose or intent of the entity?
Does the entity generate income or conduct business with regards to the appreciation of owned property, private residential rental income, management of wealth for the benefit of the principal owners or incidental business?
Please provide details about the income generation and business conducted by this entity.
Does the entity generate income in any other ways?
Please provide details about how this entity generates income.
Does the entity own any other real estate, vehicles, watercraft or other tangible assets?
Please list the other assets this entity owns: (I.e. Address, vehicles, watercraft, etc...)
Does the entity have any employees?
Please list the name and occupation for each of the employees:
Please describe how the employees are paid. (Ie. Frequency, Payroll Service, etc...)
Does the entity maintain any other insurance policies?
Please provide the insurance company name(s), coverage type and coverage limits for the other policies.
Residence Details
Does this condo/co-op have an alarm system?
Select the components of your alarm system.
What other components do you have in your alarm system?
Does this unit have fire sprinklers?
What is the square footage of this unit? (Under air)
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What year was this condo/co-op built?
What year was this condo/co-op built?
How many stories does this building have?
On which floor is this unit located?
Select the elements of this condo/co-op that have been updated.
What other updates have been done to your home?
What year was the electrical updated?
What year was the plumbing updated?
What year was the heating system updated?
What year were the windows updated?
What is the age of the building's roof?
What type of roof does this building have?
Please provide a description of this building's roof type.
Has a 4-point inspection been done on this condominium/cooperative?
Please upload a copy of the 4-point inspection, if available.
Do you have a windstorm mitigation inspection certificate for this condominium/cooperative or for the association?
Please upload a copy of the windstorm/wind mitigation certificate, if available.
Do you know of any previous renovations done to this unit?
Please share the information you have about any previous renovations in this unit.
What would it cost to replace your personal belongings at this location? (I.e. Clothing, furniture, rugs, electronics, etc...)
Would you like to include mold/fungi coverage in your proposal?
Have you had any insurance claims in the last five years? *
Please provide details about any insurance claim(s) in the last five years. *
Have there been any insurance claims at this location in the last five years? *
Please provide details about any insurance claim(s) in the last five years. *
Would you like a flood insurance proposal for this condo/co-op? *
Flood Insurance Information
Has the condo/co-op been substantially improved since it was built? (Over 50% of the market value was spent to renovate)
Where is the machinery that services this unit located? (Air conditioning, Furnace, Boiler, etc...)
Please describe where the machinery for this residence is located.
Where is your personal property kept at this location?
Please describe where the personal property is kept at this location.
Does this condo/co-op have flood vents?
Is there a flood insurance policy in place today?
Please upload a copy of the Flood insurance policy, if available.
Is the flood policy being cancelled or non-renewed?
Please share the insurer's reason for cancelling or non-renewing your policy.
Do you have an elevation certificate for the building from the condo/co-op association?
Please upload a copy of the elevation certificate
Have there been any flood insurance claims in this unit? *
Have you been paid over $5,000 on any flood claims in the last 10 years?
Please provide details about the flood insurance claims at this residence.
Documents and Comments
Please use this field to upload any relevant insurance documents. (I.e. By-laws of the association, current policy declarations pages, etc...)
Please enter any additional remarks in the space below.
How did you hear about us?
Please share who referred you to us.
Please share what you typed into Google.
Please share how you heard about us.
Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
