Homeowners Insurance in Lynchburg, VA

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*Name

*Date of Birth

*Property address to be insured

Is this a new purchase, or your current residence?

*If you have lived at this address less than 5 years, please provide your prior address.

*Is this home deeded in the name of an LLC or Trust?

*What company is your current homeowners insurance with and how long?

*Have you had a homeowners insurance policy be nonrenewed or cancelled by the company in the past 5 year? If so, please provide details.

*Is the home a mobile home, modular home or stick built?

*Year Built:

*Age of roof:

*Type of Heat and age:

*Electrical Amp service and year of last update?

*Any knob and tube wiring or fuses in the home?

*Plumbing type?

*Dog(s)? If so what breed(s) and do they have a bite history?

*Farm animals or exotic pets?

*Pool? (Inground, Above Ground, Locking fence, Diving Board, Slide)

*Trampoline? (Netted and anchored?)

*Woodstove?

*Fireplace? (Woodburning or Propane)

*Are any businesses operated out of the home including short term rentals? If yes, please provide details and General Liability Company

*How many residents?

*Any bankruptcy or judgements in the last 7 years?

*Phone number

*Email

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Home Insurance Underwriting Questionnaire

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