HO and DP Quote Application HO DP Application for Quote Agent Name/Agency: * Agent’s Email * Insured’s Name: * Insured’s Mailing Address: * Insured’s Mailing City * Insured’s Mailing State * Insured’s Mailing Zip * Insured’s SSN: 123-45-6789 Insured’s DOB * mm/dd/yyyy Type Of Quote * DP1DP2HO8HO8 w/waterHO3SeasonalVacantBuilders Risk Mortgagee Name Mortgagee Address Loan # Risk Location Address: * Risk Location City * Risk Location County * Risk Location State * Risk Location Zip * Construction Type * FrameMetalCinder BlockMobile HomePre-Fab / Modular Year Built * yyyy Roof (Age & Composition * Square Foot * Market Value * example: $100,000 Occupancy * PrimarySecondaryTenantVacant Protection Class * 12345678910 A: Dwelling Amount of Coverage: * B: Other Structures Amount of Coverage: * C: Personal Property Amount of Coverage: * Loss of Use: Amount of Coverage: * Premises Liability: Amount of Coverage: * Underwriting Comments / Additional Information: Underwriting Questions: 1. Is risk occupied by more than 1 family? * YesNo 2. Is business conducted at risk location (if yes, cannot provide a quote.) * YesNo 3. Is risk located on more than 10 acres of land? * YesNo 4. Is there a body of water (i.e. lake, pond, creek) on the premises? * YesNo 5. Is there a wood burning stove (is yes, cannot provide a quote.) * YesNo 6. Has risk been cancelled, non-renewed, or declined by another company? * YesNo 6a. If yes, please explain. 7. Has insured filed bankruptcy in last 3 years? * YesNo 8. Any previous fire losses? * YesNo 8a. If yes, please explain. 9. Any previous losses in the last 5 years? * YesNo 9a. If yes, please explain. 10. Have there been any updates to plumbing & electrical? * YesNo 10a. If yes, please list year: Plumbing 10b. If yes, please list year: Electrical 11. Does risk have central heat & air? * YesNo 11a. If no, what is used for heat source? 12. Is insured gainfully employed? * YesNo 13. Please advise how many years you have known the applicant? 14. Is this a new purchase? * YesNo 14a. If yes, what is the purchase price? 15. If not a new purchase, is risk currently insured? (Type of policy form and dates) * 16. Is property managed by a management company or someone other than the insured? * YesNo 16a. If yes, who? Submit Δ If you have additional files, photos, loss runs, etc.… that you would like to submit, please email to quotes@owensins.com. Share this:TwitterFacebookLike this:Like Loading...