Condo Questionnaire

URL

This field is for validation purposes and should be left unchanged.

Name(Required)

Date of Birth

Phone Number

Email Address or Other Contact

Name (Spouse)

Date of Birth (Spouse)

Location Address

(Please also list mailing address if different) (If you've lived at this address less than 5 years, please list prior address also)

Property Information

Year of Construction

Style of Home (1 storey, 2 storey, etc)

Above Ground Square Footage

Below Ground Construction

(Basement/Slab/Crawl: If basement, % finished:)

Exterior Construction

Number of Baths (# of full & # of 1/2)

Central Air

Yes

Fireplace (Yes/No, Gas/Wood/Wood Stove)

Flooring: (% of each type)

Age & Type of Heating

Age & type of electric (Circuit Breakers/Fuses)

Security or Sprinkler System (If yes, what?)

Repairs Needed

Please list type & value of Additions & Alterations to the original construction

Current Insurance Information

Current Coverages (Include company, effective date, coverages, deductible & endorsements)

Additional Information

According to your bi-laws, what part of your unit are you responsible to carry coverage on (other than your contents)?

Dwelling Coverage Desired

Personal Property Coverage Desired

(Value to replace ALL contents with NEW ones)

Contents that you are specifically concerned about replacing. List type & Value

(ie Jewelry, Guns, antiques, artwork, etc)

Purchase Date

Number of consecutive years you've carried a homeowner-type policy?

(Including home, condo, mobile home & tenant)

Property Claims in the last 5 years

(List when & what)

Smoker/Non-Smoker (All residents)

Bankruptcy in the last 5 years? (If yes, when?)

Is there a pool, hot tub or trampoline on your property? (If yes, what?)

Do you have any pets? (If yes, what breed?)

Business conducted in your home? (If yes, what?)

Deductible options you would consider

Additional Insured

Do you have any toys?

(ie boat, motorcycle, ATV, snowmobile, golf cart, RV, etc)

If you have a copy of your current "Declaration Page", please forward that to us as proof of prior coverage and to use for comparison purposes. Submission of information for a quote in no way binds coverage. Personal information will be used solely for underwriting purposes. Submission of information gives the Gary J Bach Agency permission to run all reports necessary to quote accurate insurance premiums.