Property remarks

q1 Quoted premium & producer name

q2 Car & home cross-reference policy N/A

q3 Relationship of named insureds if not spouses N/A

q4 Mailing address differs from risk address Yes N/A

q5 If yes, reason

q6 Business / commercial use of premises Yes No

q7 If yes, describe

q8 Registered in company name Yes N/A

q9 If yes, reason

q10 Short term rental Yes No

q11 If yes, duration

q12 Air BnB Yes No

q13 Vacant Yes No

q14 Coverage declined Yes N/A

q15 If yes, declination of coverage form attached Yes No

q16 Private lender is registered Yes No N/A

q17 Alarm certificate is attached if required Yes No N/A

q18 Jewelry appraisal attached if required Yes No N/A

q19 CAA membership # N/A

q20 Is 2nd location a rented dwelling Yes N/A

q32 Is any location a seasonal or secondary residence Yes N/A

q33 Woodstove Yes N/A

q34 If yes, questionnaire, photos, WETT certificate attached Yes No

q35 Oil tank Yes N/A

q36 If yes, questionnaire and photos attached Yes No

q37 Approving underwriter name and reference number N/A

q38 Additional comments N/A