Renters Insurance




Regardless of the type of apartment or even home you rent, we can provide you with the protection you need to safeguard your personal property when tragedy strikes.

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Personal Information

First Name Last Name Date of Birth
Street Address City Postal Code
Email Occupation Phone Number

Do you have a spouse? YesNo
[group spouse-lease]

Is your spouse listed in the lease agreement? YesNo

[/group]
[group spouse-details]

Spouse Name Spouse Date of Birth Spouse Occupation

[/group]

How long have you lived at this address? Less than 3 yearsMore than 3 years

[group previous-address]

What was your prior address?
[/group]

Do you have Renters Insurance? YesNo

[group current-renters-insurance]

Name of Insurance Company Policy Number How long have you been insured?

[/group]

Have you had any losses in the last 5 years? YesNo

[group losses-last-5-years]

Describe your losses
[/group]

Building Information

Age of the Building Total Square Feet
Number of Bedrooms Number of Bathrooms
What is the total value of the current contents (clothes, furniture, appliances, etc.)

Does the unit have an alarm system? YesNo

[group has-alarm]

Is the alarm monitored? YesNo

[group alarm-monitored]

Name of the alarm company Monitoring Station

[/group]
[/group]

Does the building have a sprinkler system? YesNo

[group building-sprinkler]

Does the unit have a sprinkler system? YesNo

[group sprinkler-type]

Is it a full or partial sprinkler system? FullPartial

[/group]
[/group]

Are there any other security measures in the building?

Any other comments?