SaveMillions - Homeowner's
Insurance Worksheet
Information to give agents or insurance companies
Address of property to be insured: ____________________________________
Number of
losses in past three years: ____________________________________
Description of dwelling:
Number of apartments or households in
building ______________________________
Construction
materials (frame, brick, etc.) ______________________________
Number of stories ______________________________
Number of rooms ______________________________
Total square feet ______________________________
Age of dwelling ______________________________
Age of roof ______________________________
Age/type of furnace ______________________________
Number of smoke detectors ______________________________
Security devices ______________________________
Owner
occupant? ______________________________
Inside city limits? ______________________________
Name of fire department ______________________________
Distance from fire
hydrant/fire station ______________________________
Business in
the home? ______________________________
Current
dwelling replacement cost ______________________________
Current
market value of dwelling and land ______________________________
Purchase
price of dwelling ______________________________
Property coverage:
Dwelling (100% of replacement cost) ______________________________
Other structures (detached
garage, shed, fence) ______________________________
Personal property (contents
of home) ______________________________
Living expense (usually 20%
of dwelling coverage) ______________________________
Deductible for property coverage:
$500 or $1,000 (the higher, the less your premium) ______________________________
Liability coverage:
Personal liability (bodily injury and
property damage) ______________________________
Medical payments to others ______________________________
Riders:
Business activities ______________________________
Earthquake ______________________________
Flood ______________________________
Scheduled
property (computer, jewelry, etc.) ______________________________
Secondary resident (vacation
home) ______________________________
Windstorm (not included in
some coastal areas) ______________________________
Information to get from agents or
insurance companies
Current #2 #3
Insurance
company name __________ __________ __________
Policy form
(perils included) __________ __________ __________
Coverage
exclusions __________ __________ __________
Inflation
guard included? __________ __________ __________
Discounts available:
Auto policy with same insurer __________ __________ __________
New home/renovation __________ __________ __________
Nonsmoker __________ __________ __________
Renewal/longtime policyholder __________ __________ __________
Security devices __________ __________ __________
Senior citizen __________ __________ __________
Smoke detectors/fire extinguishers __________ __________ __________
Fire-retardant roof __________ __________ __________
Storm shutters __________ __________ __________
Other __________ __________ __________
Annual premium: __________ __________ __________
Installment charges (if applicable): __________ __________ __________