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Underwriting Questionnaire (2024)

"*" indicates required fields

Step 1 of 7

Insured's Name*

First Last

Insured's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact name*

First Last

Contact Email

Phone*

Website

Building / Structure Information

Number of Buildings on Property*

BUILDING ONE

Building Address*

Street Address Address Line 2 City State ZIP Code

Building #

Year built*

For example: wood, fire resistant, joisted masonry, etc.

# of Stories*

# of Dwelling Units*

# of Non-dwelling Units

Building Sq Ft.*

Structure Value*

Contents Value

Rental Income Value

Solar Panels Value

Total Structure Value*

Value per Sq. Ft.*

BUILDING TWO

Building Address*

Street Address Address Line 2 City State ZIP Code

Building #

Year built*

# of Stories*

# of Dwelling Units*

# of Non-dwelling Units

Building Sq Ft.*

Structure Value*

Contents Value

Rental Income Value

Solar Panels Value

BUILDING THREE

Building Address*

Street Address Address Line 2 City State ZIP Code

Building #

Year built*

# of Stories*

# of Dwelling Units*

# of Non-dwelling Units

Building Sq Ft.*

Structure Value*

Contents Value

Rental Income Value

Solar Panels Value

BUILDING FOUR

Building Address*

Street Address Address Line 2 City State ZIP Code

Building #

Year built*

# of Stories*

# of Dwelling Units*

# of Non-dwelling Units

Building Sq Ft.*

Structure Value*

Contents Value

Rental Income Value

Solar Panels Value

Underwriting Questionnaire (2024)

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