sample-personal-quote – Insurance Forms

Insured Address
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There are no Apartments.

Insured Address
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There are no Townhomes or Condos.

Type of Occupancy
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There are no Homes.

Name	Policy Value	Type of Life Insurance
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There are no Entries.

Insured Address
	Edit Delete
There are no Apartments.

Insured Address
	Edit Delete
There are no Townhomes or Condos.

Type of Occupancy
	Edit Delete
There are no Homes.

Name	Policy Value	Type of Life Insurance
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There are no Entries.

Driver Name*
First Last
Date of Birth*
Month
Day
Year
License State*
License #*

Insured Address*
Street Address Address Line 2 City State ZIP Code
Occupancy
Are you the owner or a tenant?*
- Owner
- Tenant
Type of Occupancy*
Heated Square Footage*
What year was the structure built?*

Insured Address*
Street Address Address Line 2 City State ZIP Code
Type of Occupancy*
Heated Square Footage*
What year was the structure built?*

Some tips in case you haven't discussed with an agent...the building (Coverage A) amount for condos depends on the level of coverage required by your association. It could include built in appliances and mechanical systems, "walls in" (cabinets, flooring, etc), or the entire interior of the unit including interior walls. Even if your association covers the entire unit with a master policy, it is usually a good idea to have some of your own coverage if there have been any upgrades, or in the event that the master policy is not sufficient to pay for a catastrophic loss.
Select Coverage Limits
Coverage A (Dwelling)*
Coverage C (Personal Property Coverage)*
The amount of coverage for all contents within the home.
Coverage E (Liability)*
Deductible*
Would you like to schedule any jewelry or other high value items?
- Jewelry Coverage
- Other
Arts, fur, guns, etc...
Total Value of Jewelry*
Other Coverage Selection - Provide description and value of property*
Optional Details
Makes the quote more accurate if you know this stuff...but not required right now.
How many claims have you had in the last 5 years?
Include claims on other properties if this is a new purchase.
Please provide details for each loss (date, type of loss, amount paid by carrier, etc.).*
When was the roof last replaced?
When was the heating system last serviced/replaced?
When was the plumbing last replaced?
When was the electrical system last replaced?

Use Physical Address Entered
- Use Physical Address Entered
Insured Address*
Street Address Address Line 2 City State ZIP Code
Are you the owner or a tenant?*
- Owner
- Tenant
Type of Occupancy*
Heated Square Footage*
Do not include unfinished or unheated area.
What year was the structure built?*

Life
Who is the Life Insurance quote for?*
Name
First Last
Date of Birth*
MM slash DD slash YYYY
Policy Value*
Other Policy Value

Personal Quote

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Applicant

Auto

Auto

Policy Level Coverage

Boat

Liability Coverage

Home

Life

Umbrella

Internal Use Only (Click to expand)

Agency Info (prefilled)

Applicant

Auto

Auto

Policy Level Coverage

Boat

Liability Coverage

Home

Life

Umbrella

Internal Use Only (Click to expand)

Agency Info (prefilled)

Occupancy

Coverage

Optional Details

Select Coverage Limits

Optional Details

Select Coverage Limits

Optional Info (Click to Expand)

Life

Driver Name	Date of Birth	License State	License #
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There are no Drivers.

Year	Make	Model	Comprehensive Deductible	Collision Deductible	Other Coverage
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There are no Vehicles.

Description	VIN	Value

Year	Make	Model	Value of Watercraft (not including trailer)
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There are no Boats.