When a person desires to insure property, they fill an insurance proposal form then submit it to their preferred insurance company for scrutiny and approval. A typical insurance proposal form looks like the sample below although in some instances the details may vary, depending on item being insured and the insurance company.
Insurance proposal form
Company name: _______________________________ Policy. Number _______________
Address: ____________________ City _____________ State: ___________ Zip: _______
Phone: ________________ Email: _________________ Website: ____________________
Personal details:
Full names: _______________________________ S. Security Number ____________
Address: ____________________ City _____________ State: ___________ Zip: _______
Phone: ________________ Email: _________________ Fax: ________________________
Employer: ________________________________________________________________
Property Details: Building.
Property to be insured: ______________________________________________________
Address: _____________________________ City ___________ State____________
Is the property to be insured occupied at least five days every week? __________________
Material used to construct property _____________________________________________
Property’s condition (state of repair) ____________________________________________
How is the property maintained? _______________________________________________
Any special exposure to storm, floods and other acts of God _________________________
Date of cover: From _________________________ to __________________________
Name of previous and present insurers and policy number(s) ________________________
_________________________________________________________________________
The year the building was built (approximate) ____________________________________
Sum to be insured: _________________________________________________________
Description ________________________________________________________________
Signature: _______________________________ Date: _______________________
Received by: ______________________________________________________________
Signature: _______________________________ Date: _______________________
Approved: _______________________________ Declined: ____________________
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