Insurance HO-6 Application & Required Documents

Insurance HO-6 Application & Required Documents

Applicant / Insured Information

Applicant Name:

Date of Birth:    Phone:

Email:    SSN / Tax ID (last 4 digits preferred):

Is the applicant the unit owner:    Is the unit tenant-occupied:

Policy Details

Policy Type:    Policy Number (if renewal):

Policy Period From: To:

Coverage Options (select applicable)

Personal Property (Coverage C)    Loss of Use (Additional Living Expense)

Loss Assessment Coverage    Ordinance or Law (increased cost of repair)

Scheduled Personal Property    Water Backup / Sump Overflow

Identity Fraud Expense Coverage    Equipment Breakdown

Property Attributes & Loss History

Year Unit Constructed:    Date of last major renovation:

Protective Devices (check all that apply):

Smoke / CO Detectors    Burglar Alarm    Fire Sprinkler System

Deadbolt Locks    Central Station Monitoring

Prior insurance claims in the past 5 years: Yes    No

Exclusions, Limitations & Applicant Acknowledgments

The applicant acknowledges that the standard HO-6 policy form contains exclusions and limitations, including but not limited to: flood, surface water, earthquake, earth movement, wear and tear, infestations, intentional acts, nuclear hazard and certain business pursuits. Coverage for flood, earthquake, ordinance/law and similar perils may be available only by separate endorsement and may be subject to additional premium and deductible terms.

Applicant acknowledges reading and understanding standard exclusions and limitations contained in the policy form.

Required Documents Checklist (attach where applicable)

Please provide the following documents. Upload each required document or mark N/A where not applicable.

Recorded deed or proof of unit ownership

Condominium association master policy declarations page

Current declarations page from existing HO or renters policy

Recent interior photographs of unit (rooms showing improvements)

Receipts or invoices for major improvements or fixtures

Floor plan or unit layout showing boundaries of insured interior

Proof of identity (photo ID)

Tenant lease (if unit is rented)

Beneficiary / Payee Information

Primary Payee for claim proceeds (if other than applicant):

Declarations, Authorizations & Fraud Warning

By signing below, the applicant declares that all statements and answers in this application are complete and true to the best of the applicant's knowledge and belief. The applicant understands that any material misrepresentation or omission of fact may render the policy null and void or permit the insurer to deny coverage for a claim and/or rescind the policy.

The applicant authorizes the insurer and its representatives to obtain underwriting, claims and loss history information, and any relevant credit information, and to exchange such information with prior insurers and third-party reporting agencies for underwriting and claims handling purposes. This authorization shall remain in force for the purpose of procuring and servicing insurance.

The applicant acknowledges that the insurer may require additional documentation or inspection of the insured unit prior to binding coverage. The applicant further acknowledges responsibility to disclose to the insurer any material change in occupancy, ownership, or risk conditions that occur prior to policy inception or during the policy period.

I certify that the information provided in this application is true and complete and I understand that false statements may constitute insurance fraud.

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