Landlord Dwelling Insurance Application – Tiger Insurance Group LLC

Landlord - Dwelling - Insurance Application

Submit your Landlord / Dwelling application today!

"*" indicates required fields

1Landlord / Dwelling Insurance Quote

2Converages

3Underwriting Questions

4General Information

5Final Details

Landlord / Dwelling Fire Insurance Application

Save up to 20% on your insurance. Get a quote and get covered.

Applicant

Name

First Last

Date of Birth*

MM slash DD slash YYYY

Social Security Number

Marital Status*

Primary Email

Primary Phone*

Primary Phone Type*

Cell

Business

Home

Occupation*

Employer Name*

Policy Effective Date*

MM slash DD slash YYYY

Location Address*

Street Address Address Line 2 City State ZIP Code

Has the applicant owned this location for at least 3 years?*

Yes

Co-Applicant?*

Yes

Co-Applicant Information

Name	Primary Phone Number	Actions

There are no Co-Applicants.

Maximum number of co-applicants reached.

Is the named insured the owner of the property?*

Yes

All owners other than applicant and co-applicant need to be added as Additional Insured.

Is there an additional interest on this property?*

Yes

Additional Interest Information

Interest Type	Name	Actions

There are no Entries.

Maximum number of entries reached.

COVERAGES

Deductible*

Dwelling*

Other Structures*

Personal Property

Fair Rental

Premises Liability (Each Occurrence)*

Medical Payments (Each Person)*

Building Ordinance or Law

Debris Removal

% Building Ordinance / Law*

Value of Debris Removal*

Inflation Guard

Loss Assessment

% Inflation Guard*

Value Loss Assessment*

Personal Injury

Plants, Shrubs and Trees

Value Plants etc.*

Flood coverage

Water Backup of Sewers and Drains

Water Back up Deductible*

Earthquake

Deductible*

Retrofit Type*

Yes

Office, Professional, Private School, Studio - Residential Premises

UNDERWRITING QUESTIONS

Extend Liability To Multiple locations?*

Yes

Liability Locations

Location Address	Actions

There are no Additional Interest.

Maximum number of additional interest reached.

Prior Carrier?*

The Umbrella liability provides a layer of excess insurance over specifically identified primary polices; business liability on the general liability, automobile liability, liquor liability and employers liability.

Yes

Carrier?*

Policy Number?*

Expiration Date*

MM slash DD slash YYYY

Expiring Premium?*

Construction Type*

Usage Type*

Siding*

Siding Other*

Roofing Condition

Residence Type

Occupancy

Roofing Material

Plumbing System Condition

Any Known Leaks?

Yes

Housekeeping Condition

Purchase Date*

MM slash DD slash YYYY

Purchase Price*

Security*

Visible From Road

Occupied Daily

Visible to Neighbors

Door Lock - Dead Bolt

None

Sprinkler

Yes

Fire District Name

Distance to Hydrant

Distance to Fire Station

Primary Heat Type

Primary Heat Description

Secondary Heat Type

Secondary Heat Description

Heating System Serviced

Yes

Last Date of Service*

MM slash DD slash YYYY

Electrical System

Wiring

# of Amperage

Year Built

Square Footage

Market Value

# of Families (Units)

Please enter a number from 1 to 4.

# of Household Residents

# Weeks/Yr Rented

Dwelling Location

Foundation

Oil Storage Tank

Yes

Fuel Line Location*

Tank Location*

Swimming Pool*

Yes

Type*

Approved Fence*

Yes

Diving Board*

Yes

Slide*

Yes

Wiring

Yes

Type*

Year*

Plumbing

Yes

Type*

Year*

Heating

Yes

Type*

Year*

Roofing

Yes

Type*

Year*

Exterior Paint

Yes

Year*

GENERAL INFORMATION

Any Coverage Declined, Canceled, or Non-renewed during last 3 years? (Missouri Applicants do not answer this question)

Yes

Prior Coverage Action*

Do you own any Recreational Vehicles?

Yes

Year

Make

Model

Year

Make

Model

Any Business Conducted on Premises?

Yes

Business Conducted on Premises*

Farming

Home Office/Business

Telecommuter

Daycare

Other

Other Business Description*

Any Residence Employees?

Yes

Residence Employee Count*

Job Descriptions*

Are there any Animals or Exotic pets kept on premises?

Yes

Animal Type*

Breed*

Bite History?*

Yes

Animal Type*

Breed*

Bite History?*

Yes

Is there a Trampoline on the Premises?*

Yes

Is there a safety Net?*

Yes

Any Lead Paint Hazard?*

Yes

Lead Paint Descriptions*

Is the Residence in a Gated Community?*

Yes

Community name?*

Any other Residences (Owned, Occupied, Rented)?

Yes

Other Residence*

Owned

Occupied

Rented

Other Residence Description*

Any exposure to flood, brush/forest fire, landslide?

Yes

Other Exposures*

Flooding

Brush

Forest Fire

Landslide

Other

Other Exposure Description*

Is property situated on more than 1 Acre?

Yes

Property Size*

Land Use*

Any uncorrected fire or building code violations?

Yes

Description*

Is this property For Sale?

Yes

Was the structure originally built for use other than a private residence and then converted?

Yes

Description*

Is this property within 300 feet of a commercial or non-residential property?

Yes

Description*

Is there an approved carbon monoxide alarm in operating condition within the mandated number of feet of every room used for sleeping purposes? (IL = 15FT.)

Yes

Is building under construction or undergoing renovation or reconstruction?

Yes

Include Builders Risk Theft BLD Materials?*

Yes

Limit*

Course of Construction*

Is the Applicant the general contractor?*

Yes

Start Date*

MM slash DD slash YYYY

Est. Completion Date*

MM slash DD slash YYYY

Interior %*

Exterior %*

Addition SQ.FT.*

Add Level SQ.FT.*

Structural Changes?*

Yes

Occupied During Renovation?*

Yes

Materials Unattached*

Cost of Project*

Has the Applicant had a Foreclosure, Repossession, Bankruptcy, or filed for Bankruptcy during the past 5 yrs?

Yes

Explain BK Etc...*

Yes No Has the applicant had a judgement or lien during the past five(5) years?

Yes

Explain judgments Etc...*

During the past 5 yrs (10 yrs in RI), has the applicant, to any degree, been indicted for or convicted of these crime(s): fraud, bribery, arson or any other arson-related crime in connection with this or any other property?

Yes

Explain judgments Etc...*

FINAL DETAILS

Any Prior Losses*

Yes

Nest Prior Loss

Loss Date	Loss Type	Actions

There are no Prior Losses.

Maximum number of prior losses reached.

Any other related topics you wish to disclose?*

Yes

Disclosure Details*

Attachments Included

Photographs

Other

Attachments (Any optional or pertinent information to include with this application)

Max. file size: 750 MB.

Consent*

*To provide you with an accurate quote, our carrier partners obtain information about you and other household members from consumer reporting agencies. This includes credit-based insurance score, driving and claim histories and other consumer reports. They use this information to underwrite and rate your policy. They may order additional reports to update or renew your insurance. Our carrier partners may use a third party to develop a credit-based insurance score. Not all reports are ordered in all states.

* I affirm that I have reviewed this information with the customer as required by law.

info@tigerinsurancegroup.com

702.518.1535

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