Form - Property Questionnaire - Darling Insurance

Applicant Name *

Applicants on deed/lease agreement *

	Name of Applicant *	Applicant DOB *
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Phone Number *

Email *

Address to be insured *

Mailing address if different

Current Insurance Renewal Date

How long have you been with your current insurer

How long have you had property insurance

Any cancellation by any insurer in the last 5 years

Number of mortgages on the property

Does anyone smoke

Are you a CAA member

What is your Membership Number *

Any claims in the last 5 years

What happened and when *

Do you rent out any portion of your home or run any type of business

What is it/how many renters *

Year Built *

Sq. Footage *

Building Type *

Please Specify Building Type *

Construction Type *

Please Specify Construction Type *

Exterior Type *

Please Specify Exterior Type *

Basement Type *

Please Specify Basement Type *

%Finished

Garage *

Garage Type *

Please Specify Garage Type *

Number of Full Bathrooms

Number of Half Bathrooms

Is there a pool or hot tub

Heating Type *

Please Specify Heating Type *

Fuel Source

Please Specify Fuel Source *

Heating Type Year of last update

Aux Heat

Please Specify Aux Heat *

Electric Type *

Please Specify Electric Type *

Type

Breakers
Fuses
100 AMP
200 AMP

Electric Type Year of Last Update *

Roof Type *

Please Specify Roof Type *

Roof Year of last update *

Plumbing Type *

Please Specify Plumbing Type *

Plumbing Type Year of last update *

Are there any outbuildings? ie. Sheds, Detached Garage or Workshop

Please Specify outbuildings *

Do you have any unique or specific details about the risk that have not been covered in this form

Please Specify Any unique or specific details about the risk that have not been covered in this form *

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Form – Property Questionnaire

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