Insurance Rental Condo Application

INSURANCE RENTAL CONDO APPLICATION

Applicant / Insured Information

Applicant Name:

Property / Condo Unit Information

Unit / Building Identifier:     Year Built:

Construction Type:     Square Footage:

Owner-occupied (not rental)     Tenant-occupied (rental)     Vacant

Policy Details Requested

Coverage — Building / Alterations:    Personal Property Coverage:

Liability Limit:    Deductible:    Annual Premium:

Policy Period From:    To:

Coverage Options (Select all that apply)

Bodily injury & property damage liability     Loss of rents / Rental income     Vandalism & malicious mischief

Theft of tenant-owned property (if covered)     Water damage (sudden & accidental)     Umbrella / excess liability

Earthquake (optional endorsement)     Flood (must be bound as separate policy)     Ordinance or law coverage (enforcement)

Prior Insurance and Loss History

Prior insurer (most recent):     Policy number:

Yes     No

Date of loss:    Amount paid:

Supporting Documentation Checklist

Copy of current lease agreement     Proof of ownership / condo deed

Photographs of unit interior & exterior     Prior policy declarations page

Smoke/CO detector compliance documentation     Other:

Exclusions and Important Notices

The policy applied for will contain standard exclusions including but not limited to: wear and tear, gradual deterioration, latent defect, intentional acts by the insured, nuclear hazard, war, and losses caused by failure to maintain the property. Optional perils such as flood and earthquake are excluded unless specifically endorsed. Applicant acknowledges review of these standard exclusions.

Applicant Initials acknowledging exclusions:   

Beneficiary / Loss Payee & Mortgagee

Relationship:    Percentage:

Declarations and Certification

I certify that the information provided in this application is true, complete and accurate to the best of my knowledge. I understand that material misrepresentations or omissions may void coverage or be the basis for rescission of the policy. I authorize the company and its representatives to obtain and verify information pertaining to this application, including inspection of the described property and inquiry into past loss history. I understand that coverage is not in effect until a policy is issued and the required premium is paid.

Fraud Warning: Where applicable by law, any person who knowingly submits false information or conceals material facts for the purpose of obtaining insurance may be subject to criminal and civil penalties under applicable statutes.

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