Vacant Dwelling Name(s) of all person(s) who own this property: Your MAILING address: Your email address: Address of insured property: Best Phone number to call you back at:How many years have you owned this property? or date purchased? Which date do you require insurance on this property? MM slash DD slash YYYY Any claims in the last 5 years? If yes, please state date of loss, amount paid out by ins. company and briefly outline what happened.Year home built If you have a current insurance policy on this location, please send first few pagesMax. file size: 10 MB.File must be 10 MB or lessPlease send us a photo of your homeMax. file size: 10 MB.File must be 10 MB or lessApprox. how long will this property be vacant? less than 1 month 1 month to 3 months 3 months to 6 months 6 months to One year What are the future plans for this property? Do some cosmetic renovations and up for sale Do some cosmetic renovations and move in to this home within 3 months Will increase the square footage and do a substancial renovation Will demolish this home and build a new home for myself Will demolish this home and build a spec home to put up for sale Will you be increasing the square footage of the existing home ? Yes No Is this home within 300 meters of a fire hydrant & within 8kms of a manned firehall ? Yes No Do you have a registered mortgage on this home? Yes - with a Bank in Canada Yes - with a private lender No - this property is clear title I have a credit line on this home and the bank does NOT need to be named on the policy. Square footage of basement below ground level: Square footage of first floor above ground: Square footage of second floor above ground: Square footage of third floor above ground: Do you have any of the following: Laneway house rented out to one family Shed detached Solarium attached solarium any other detached living space Do you have any flat glass or dome glassed skylights Are the exterior walls of this home mostly: 2x6 2x4 I'm not sure. Are the interior walls of this home mostly: 2x6 2x4 I'm not sure. If you have a basement below ground, is it mostly: finished unfinished I do not have a basement Does your basement have a walk out Yes No I don't have a basement below ground level What is the primary material of the exterior walls of the home: stucco stucco with 10% stone/brick veneer vinyl cedar combination of stucco and wood aluminum hardi plank other , not listed here What percentage of this property has 8 foot ceilings: What percentage of this property has 9 foot ceilings: What percentage of this property has vaulted celilings (over 10ft) What type of roof do you have? Asphalt shingles Torch on Tar and gravel Concrete tile Clay tile Metal Other What year was your roof last replaced Do you have any garages or carports? detached garage for 1 car detached garage for 2 cars detached carport for 1 car detached carport for 2 cars built in garage for 1 car built in garage for 2 cars none Please estimate percentage of each of these types of flooring in the entire home (hardwood, tile, carpet, laminate, linoleum, polished concrete)How many kitchens do you have ? 1 2 3 4 5 How many bathrooms do you have ? 1 2 3 4 5 Do you have wood burning fireplace(s)? Yes, 1 fireplace connected to a brick chimney Yes, 2 fireplaces connected to a brick chimney No, I do not have a brick chimney. Do you have any natural gas fireplaces? Yes, 1 direct vent Yes, 2 direct vent Yes, 1 passing through a B-Vent Yes, 2 passing through a B-Vent No, I do not have a natural gas fireplace Do you have a free standing wood burning stove? No Yes and I have a passed WETT inspection Yes and I do NOT have a WETT inspection. What type of heating do you have? Hot warm (forced) air (natural gas) Hot water baseboard (natural gas) Radiant in-floor hot water heating Electric Baseboard Electric in floor heating Do you have a cooling system? No, I do not Yes, and I use the same ducts as my hot air system Yes, and I use separate ducts as my hot air system. Yes, I have high efficiency central air using same ducts Yes, I have high efficiency using separate ducts Please check mark if you have any of the following: local burglar alarm monitored burglar alarm monitored burglar & fire alarm interior sprinklers water sensors Oil tank water leak detection system back water valve sump pump battery Please confirm type(s) of plumbing you have? Copper - original when year home was built Plastic - original when home Was built Copper - redone in the last 15 years Plastic - redone in the last 15 years Cast iron Galvanized Poly B plumbing Poly B plumbing with crimp rings Please confirm type of electrical you have ? 100 amp circuit breakers 200 amp circuit breakers knob and tube aluminum wiring fuses Year hot water tank replaced? Year your furnace/boiler was replaced? Would you like an exterior glass breakage policy Yes No How did you find out about our office? I have an existing home policy with your office. I was referred by someone. I found you via google search I noticed your office when I was driving/walking by. I am a personal client of one of your producer/ staff members I am an existing auto insurance customer.
