PROPERTY QUESTIONNAIRE
Name: ____________________________
Policy #________________________________
Street Address of Location: ________________________________________________________
City/town:__________________________
Postal Code:___________________________
Phone #___________________________
Work phone #:__________________________
E-mail address:__________________________________________________________________
PRIMARY HOME (fill-in or circle)
Located within 1000 feet of hydrant?_____
If not, # km to responding fire hall__________
Year house was built: __________________
How many stories is your home: 1Storey
11/2 Storey
2Storey Duplex Bi-level
Other_______________________________
Style of home:
Detached Semi-detached Inside Row
Row end unit
Shape of Home(circle): Square Rectangle L shaped I shaped Other(specify)____________
What is the TOTAL living area:________ Sq ft (EXCLUDING THE BASEMENT)
Do you have a full basement: Yes or No Exterior entrance (walk-out basement) Yes or No
Sq ft of finished basement_________ Sq ft of Slab:_________ Sq ft of crawl space:_________
# of Bathrooms in the home: Ensuite(4 or more pieces)_______ Full ________ Half___________
Please indicate the % that is applicable for your EXTERIOR WALLS:
Brick Veneer:
____
Aluminum Siding:
____
Vinyl Siding:
____
Other:
____
Please indicate the % that is applicable for your ROOF:
Asphalt/Fiberglass Shingles: _____
Steel Roofing:
_____
Built-up/Tar & Gravel:
_____
Other:
_____
Please indicate if any of the ATTACHED STRUCTURES are applicable:
Attached Garage
____1 Car
____2 Car
____3 Car
Basement Garage
____1 Car
____2 Car
____3 Car
Carport
____1 Car
____2 Car
____3 Car
Built in Garage
____1 Car
____2 Car
____3 Car
Please indicate if you have the following and the total square footage:
Detached Garage
______ sq ft
Stable/shed
______ sq ft
Open Porch
______ sq ft
Patio Cover
______ sq ft
Closed Porch
______ sq ft
Solar Room
______ sq ft
Balcony
______ sq ft
Greenhouse
______ sq ft
Deck
______ sq ft
Breezeway
______ sq ft
Gazebo
______ sq ft
Cabana
______ sq ft
Do you have any of the following built-ins?
Central Vacuum System
____
Central Air Conditioning
____
Pool (above/inground?)
____
Monitored Burglar Alarm System
____
Monitored Fire Alarm System
____
Radiant Floor Heating (value)
____
0 Clearance Insert
____
Hot Tub (how many)
____
Woodstove (age/labeled stove?)
____
- Amount of wood used/yr
__________
What is your primary source of heat? Natural Gas Oil Electric Woodstove Other________
If your home is heated with oil, please advise: Manufacturer of tank_____________________
Age of oil tank____________
Where the tank is located: Inside or Outside?
Give dates when the following have been updated:
Wiring
__________
Plumbing
_________
Type of wiring: Aluminum/copper/other_____
Plumbing: Galvanized/ copper/ abs (circle one)
Roof
__________
Heating
_________
What is the power supply in your electrical panel?
Is it breakers or fuses? (circle one)
Do you have a mortgage?
60amp
100amp
200amp
Yes or No
What is your lawyers name and phone number (if this is a new purchase)
_______________________________________________________________________
Close Date___________________
If you are new to our office and you have moved in the last 3 years, please provide your previous
address_________________________________________________________________________
If you are new to our office, please advise if you have had prior property insurance of any kind and
for how many continuous years?_____________________________________________________
What is your prior insurance company name and policy number?____________________________
What is the purchase price of the home?__________________
Is your home a non-smoking household?
Yes or No
How many families are residing in the home? ______ Any roommates or boarders? Yes or No
Have you had any claims in the last 5 years?
Yes or No
-If yes when?_______________ Type of claim?_________________ pay out_______________
Occupations______________________________
_______________________________
If you are self-employed, is your business operated from home?
Yes or No
If you are employed by a company, do you often work from home?
Yes or No
Please describe the type of business__________________________________________________
Date of Birth:_________________________
Spouses Date of Birth:___________________
REMARKS:______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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