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Homeowners Questionnaire
Have your producers use this questionnaire from Jack Fries to garner needed information from Homeowners prospects: HOMEOWNERS INSURANCE QUESTIONNAIRE Producer: ______________________________________ Date: ___________________ INSURED Name _____________________________ Phone __________________ Address _______________________________________________________ City ______________________ State _____ Zip ____________________ Occupation ____________________________________________________ PRESENT HOME Homeowners Carrier _________________ Exp. Date_____________ LIMITS Dwelling _________________ Year Built _____________ Brick or Frame Additional Structures _______________ Liab. ___________ Contents _________________________ Medical ________ Loss of Use _______________________ Deductible ______ Prior Claims _______________________ Premium _______ Credits - Alarm, etc.________________________________ Guaranteed Replacement: Home Contents Additions/Alterations 'All Risk' Contents Theft Ext. Sewer Backup Subsidence Earthquake Extended Liability Scheduled Items Limits: Jewelry Furs Fine Arts (Breakage) Silver Coins Stamps Guns Boats Computers ______ Photo Equipment COMMENTS Are your autos insured with the same company? ____________ Expiration Date: _______________ RECOMMENDED Dwelling _________ Company ____________________ ­ LIMITS Liability _________ Deductible ______________ Premium ___________ Guaranteed Replacement Home ____ Contents 'All Risk' Contents Sewer Backup ____ Other REPLACEMENT Number of families Year Built _________ Sq. Ft _________ COMPUTATION Brick Frame Garage Cars Brick Frame Attached Balcony Porch Deck Sq. Ft. # of Fireplaces ____ # of Chimneys Inside Outside # of Baths Full 1/2 Basement? Finished? Central Air? ___ Wiring: -- Year Update: _________ Heating Construction Type I, II, III, IV Plumbing: -- Year Update: _______ Roof: -- Year Update: ___________ Built-ins: Stove Refrigerator Dishwasher Washer Dryer Sauna Hot Tub Replacement value _______ Market Value __________