Home or Condominium Information

Property Location (Address):
Year Built:
Structure Type:	Brick   Frame
Dwelling Coverage Limits:	$
Contents Coverage Limit:	$
Primary Heat Source:	Electric   Natural Gas   Oil Other
If oil, is tank in ground?	Yes   No
Square footage of living space (if known):
Number of floors:
Is there a basement?	Yes   No
Is the building elevated?	Yes   No

Schedule of Personal Property

Jewelry Limit:	$
Fur Limit:	$
Fine Art:	$
Boat Information
Year:	Length:
Manufacturer:
Model:
Num. Engines:	Horsepower per engine:
Type of Fuel:
Navigating Area:
Laid Up From:	To
Engine Type:	Inboard Outboard Stern Drive (I/O)
Top Speed:
Purchase Price:	$
Insured Value:	$
Liability Limit:	$
Years of Boating Experience:	Years as Boat Owner:
Boating Education:
Current Insurer
Insurer:
Policy Number:
Expiration Date: