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State Farm Homeowner Policy Form

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Authorization for Release of Information

State Farm Insurance Companies hereby gives you notice that it may obtain a consumer report containing credit information and/or personal information about you to assist in making an informed decision with respect to your potential employment with us. You have the right, upon request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report and a Summary of Your Rights Under the Fair Credit Reporting Act.

I, , hereby authorize State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates (hereinafter referred to as “State Farm®”), and their authorized agents to obtain an investigative consumer report which may include motor vehicle record and driver’s license verification, criminal records, prior job performance and employment verification, personal credit report, education verification, professional license verification, character, general reputation, personal characteristics, mode of living, credit standing, credit capacity, and creditworthiness.

This consumer report will be obtained on my person for the purposes indicated below:

Employment

Employment consideration, including but not limited to pre-employment screening; consideration for promotion, retention, or job reassignment; and compliance with employment-related laws;

Securities Registration Sponsorship with SFVPMC

In connection with a possible appointment to serve as a Registered Representative with State Farm VP Management Corp;

Agency (ESP and EFA)

As part of a review of my candidacy to render service as an Emergency Service Program associate (ESP).

As part of a review of my candidacy to become an employee of a future agent (EFA). Those authorized to review the ordered consumer report on my person shall include the personnel in Human Resources and other departments who review these records as well as the agency intern who may become my eventual employer.

Independent Contractor

As part of a review of my candidacy to render service as an independent contractor

1) Instructor; 3) Consultant; or

2) Claim representative; 4) ;

This authorization encompasses the ordering of an investigative consumer report, which may include interviews with my friends, neighbors, or associates. This authorization also permits any present or former employer, school, police department, financial institution, department of motor vehicles, or other persons or government agencies to furnish information about me in their possession to State Farm or its authorized agents. This authorization may be used multiple times within a 12-month period effective from the date signed for the purposes previously authorized.

If there is any inconsistency between this authorization and any applicable legal requirement pertaining to the disclosures contemplated, then this authorization shall be limited to what the law allows.

Printed Name

Social Security Number

Signature

Central Registration Depository (CRD) Number (if applicable)

Date

Address

Driver’s License Number

City, State, ZIP Code

Driver’s License State of Issuance

Authorization for Release of Information State-Specific Attachments

California, Minnesota, and Oklahoma Residents Only

Under California, Minnesota, and Oklahoma law, you have the right to receive a free copy of your consumer report by checking the box below. The consumer reporting agency will directly mail your report to the address indicated above.

YES, I am a California resident and would like a free copy of my investigative consumer report.

YES, I am a Minnesota resident and would like a free copy of my consumer report.

YES, I am an Oklahoma resident and would like a free copy of my consumer report.

NO, I would not like a copy of my consumer report.

Printed Name

Signature

For internal use only. This form and all information contained herein constitute proprietary information, which shall not be disclosed without appropriate State Farm® authorization.

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What the State Farm Homeowner Policy Form Is

The State Farm Homeowner Policy Form documents the insurance contract between the named insured and State Farm for residential property coverage. It typically includes the declarations page, insuring agreements, coverage limits, deductibles, named insured details, property description, endorsements, exclusions, and conditions that govern claims and obligations. This form establishes who is covered, what perils are insured, how losses are measured, and any mortgagee or lienholder interests. Insurers use the completed form to issue a policy, set premiums, and create enforceable contractual terms under state insurance law and the terms agreed by the parties.

Why the Form Matters for Coverage and Claims

The State Farm Homeowner Policy Form defines coverage scope, limits, and exclusions that determine claim outcomes and premium calculations. Accurate completion reduces disputes and supports timely claim handling under the policy terms and applicable state insurance regulations.

Why the Form Matters for Coverage and Claims

Who Completes and Reviews This Form

Agents, policyholders, mortgagees, and third-party administrators commonly complete or review the form during issuance, renewal, or when endorsing coverage.

  • Insurance agents and brokers verify risk data and submit for underwriting approval.
  • Homeowners (named insureds) provide personal, property, and occupancy details and must confirm accuracy.
  • Mortgagees or lienholders review endorsements and must be listed to protect their interest.

Each party’s role affects which fields must be verified: agents confirm underwriting data, policyholders confirm accuracy, and mortgagees verify interest listings.

Stepwise Process to Complete the State Farm Homeowner Policy Form

Follow these sequential steps to gather, verify, sign, and submit the completed policy form to avoid delays in issuance or renewals.

  • 01
    Gather Documents: Collect deed, prior policy, inspection reports, and mortgage details.
  • 02
    Complete Declarations: Fill named insured, property address, limits, and deductible fields.
  • 03
    Confirm Endorsements: Add wind, flood exclusions, or scheduled personal property endorsements if needed.
  • 04
    Sign & Submit: Sign by authorized party and deliver to agent or insurer for processing.

Typical Workflow From Form Completion to Policy Issuance

This sequence shows how data flows after the form is completed to produce a binding policy and how updates are handled.

  • Prepare Form: Agent or insured fills form with required details and attachments.
  • Underwriting Review: Insurer checks risk factors, prior claims, and required inspections.
  • Premium Calculation: Underwriter sets premium based on coverages and exposures.
  • Policy Issuance: Insurer issues declarations page and full policy with endorsements.

How to Configure an Online Form Workflow

When completing or sharing the form online, configure authentication, roles, and document templates to match insurer and regulator requirements.

Field Configuration
Document Type PDF or DOCX policy form
Signer Roles Named insured, agent, mortgagee as separate roles
Authentication Email link, SMS code, or multi-factor for higher assurance
Retention Enable audit trail and secure storage for regulatory compliance

Essential Sections of the State Farm Homeowner Policy Form

A professional policy form includes standardized sections that explain coverages, exclusions, conditions, and claimant procedures to minimize ambiguity and support claims processing.

Declarations

Summarizes named insured, property address, policy period, limits, deductibles, premium breakdown, and mortgagee information in one-page view for quick reference.

Insuring Agreement

Specifies the insurer’s promise to pay for covered losses caused by named perils and sets the contractual basis for claims handling and indemnity.

Coverages

Lists coverage parts such as dwelling, other structures, personal property, loss of use, and personal liability with coverage limits and sub-limits.

Exclusions

Identifies perils and circumstances the policy does not cover, such as certain floods, earth movements, wear and tear, or intentional acts.

Conditions

Details duties after loss, proof-of-loss requirements, appraisal and arbitration options, and cancellation and nonrenewal terms that affect enforceability.

Endorsements

Adds or modifies coverage (e.g., replacement cost, ordinance or law, scheduled personal property) and becomes part of the contract when attached.

Key Information Items to Verify on the Form

Policy Number: Carrier-assigned identifier
Named Insured: Full legal name
Property Address: Physical location
Coverage Types: Dwelling, liability, contents
Coverage Limits: Per-coverage dollar limits
Deductible: Selected amount or percentage

Common Preparation Pitfalls to Avoid

  • Failing to update the property address or mortgagee leads to payment or recovery complications during claims and may delay settlement.
  • Using nicknames or initials for the named insured can create identity mismatches that slow underwriting or trigger verification requests.
  • Omitting scheduled personal property or high-value items may result in limited recovery for those items after a covered loss.
  • Submitting incomplete inspection reports or photos can require supplementary documentation and lengthen the claim adjudication timeline.

Consequences of Incorrect or Omitted Information

Claim Denial: Possible denial
Policy Rescission: Policy may be voided
Premium Adjustment: Higher future premiums
Coverage Gap: Uninsured exposures
Fraud Liability: Civil or criminal penalties
Mortgage Issues: Lender may require force-placed coverage

Key Dates and Timing to Monitor

Track effective dates, renewals, and claim notice deadlines to maintain continuous coverage and meet insurer obligations.

Policy Effective Date:

Date coverage begins; use MM/DD/YYYY

Renewal Date:

Anniversary for premium and condition review

Notice of Claim:

Report losses promptly per policy terms

Proof of Loss:

Submit required documentation within insurer-specified period

Cancellation Notice:

Insurer must provide state-mandated advance notice

eSignature Vendor Pricing and Capability Snapshot

Compare common plan-start prices and core capabilities relevant to signing homeowner policy forms and supporting documents. Pricing reflects typical per-user annual billing; features vary by plan tier.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About Completing and Submitting the Form

Answers to common questions about electronic signatures, notarization, endorsements, and correcting errors on the State Farm Homeowner Policy Form.


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