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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