Landlord Insurance Form

First Name *

Last Name *

Date of Birth

Gender

Marital Status

Occupation

Email *

Phone *

Best day to contact

Best time to contact

Approximate Year Built

Approximate square footage

Address

City

State

Zip

Property Type

Exterior Walls

Roof

Number of Stories

Number of Bedrooms

Number of Bathrooms

Security system

Fire alarm

Is your building/property managed by a Licensed Property Management agent?

Yes

No

Is your building/property part of a Strata title place?

Yes

No

What standard of contents do you have?

Average - no name brands, basic equipment, self-assembled furniture, etc.

quality - well-known brands, superior equipment, standard furnitures, etc.

prestige - designer brands, handcrafted furniture, etc.

List any additional features in your property (ex. Grage, swimming pool, etc.)

Liability Protection

Deductible

Personal Property

Loss of Use

Additional Coverages/Comments