Insurance Home Sharing Application

INSURANCE HOME SHARING APPLICATION

Applicant / Insured Information

Property to Be Insured

Property Type: Primary residence Secondary residence Vacation home

Number of Units: Square Footage:

Home Sharing Activity Details

Hosting Commenced On:

Average Number of Rental Nights Per Year:

Average Number of Guests Per Stay: Maximum Guests Allowed:

Do you reside on the premises during rentals? Yes No

Are events or gatherings permitted at the property? Yes No

Do you conduct background or identity verification of guests? Yes No

Coverage Requested

Coverage Options (select all that apply):

Dwelling and Structural Damage Personal Property (furnishings, contents) Host Liability (bodily injury/property damage)

Loss of Rental Income (business interruption) Guest Injury/Medical Payments Ordinance or Law Coverage

Requested Policy Period: From to

Prior Insurance and Loss History

Have you had any insurance claims or losses in the past five (5) years? Yes No

Has any insurer cancelled or refused to renew your policy within the last five (5) years? Yes No

Safety and Security Measures

Indicate safety measures in place (check all that apply):

Smoke detectors CO detectors Fire extinguishers

Deadbolt locks on entry doors Monitored security system Pool fencing / safety barriers

Exclusions, Representations and Acknowledgements

Applicant acknowledges and agrees that coverage applied for is subject to policy terms, conditions and exclusions. Typical exclusions include, without limitation: intentional acts by the insured or guests; liability arising from willful failure to comply with local ordinances; coverage for commercial activities not disclosed and accepted in writing by the insurer; loss or liability arising from permitted events or gatherings unless expressly endorsed; theft or damage when property is left vacant for more than the period specified in the policy unless the insurer is notified in writing.

Applicant further represents: all statements in this application are true and complete to the best of the applicant's knowledge. Any material misrepresentation, omission, or incorrect statement in this application may result in denial of coverage, rescission of the policy, or refusal of claims. Applicant must notify the insurer of any material change in risk prior to such change.

Beneficiary / Payable Interest (Optional)

Provide beneficiary for policy proceeds (if applicable):

Declaration and Certification

I certify that the information provided in this application is true, complete and accurate. I understand that this application, including any attachments and statements, forms the basis for any policy issued and that the insurer may rely upon these statements. I authorize the insurer and its representatives to make any investigations and inquiries deemed necessary to evaluate my application, including inspection of the property, verification of loss history, and consumer reports where permitted by law.

I acknowledge that coverage will not be effective until a policy is issued, signed by an authorized representative, and the required premium is paid. I understand that additional information may be requested and that any change in the circumstances described in this application must be immediately reported in writing.

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