Home Insurance Questionnaire

June 15, 2011

Address of residential property to be insured (if different from above): Street address __________ City name ________ State name _________ Postal code _________

Residential Contact number: _____________ Mobile number: ________

Email id: _________________

1. What kind of residential property do you own?

a) Mansion

b) Row house

c) Apartment

d) Duplex

2. How many years has it been since you purchased your home?

a) Less than one year

b) Less than three years

c) Less than five years

d) More than five years

3. Was your home built in the same year, you purchased it?

a) Yes

b) No

4. If the answer to the above question is no, when was you home built?

_____________________________

5. Do you have any of the following security measures in your home?

a) Fire extinguisher

b) Smoke indicator

c) Security alarm

d) Security cameras

6. When did you renovate your home last time?

________________

Download Home Insurance Questionnaire in Word Format

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