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Request a Quote For Home & Personal

* Required

Application Contact Information

Prefix:

* First Name:

* Surname:

* Address 1:

Address 2:

* City:

* State / Province:

* Zip / Postal Code:

* Country:

* Citizenship:

* Country of Residence:

* Telephone:

Fax Number:

* E-mail:

 

Property Information * at least one property must be entered

How many properties?

Primary Property

* Address 1:

Address 2:

* City, State / Province:

,

* Zip / Postal Code:

* Country:

* Ownership:

* Primary Use:

* Year Purchased:

* Purchase Price:

$

* Is the property currently insured?

Yes No

* Insured Value:

$

* Insurance Company:

* Annual Premium:

$

* Effective Date:

(mm/dd/yyyy)

* Do you rent or lease this property to others?

Yes No

If Yes, then for how long?

* Do you use a property management service?

Yes No

* Is this property left vacant for more than 60 days?

Yes No

* Do you employ full-time staff?

Yes No

If Yes, then how many?

* Does any full-time staffs reside at the residence?

Yes No

* Do you have a Home Business, Consultancy or Family Office?

Yes No

Property Type

* Area (square feet):

* Year built:

* Is the property located on a farm or ranch?

Yes No

* Construction type:

* Roof type:

* Primary Heat:

* Deck?

Yes No

* Pool?

Yes No

* Basement?

Yes No

* Garage?

Yes No

* Is the property Fenced?

Yes No

* Detectors?
(Fire, Gas, Smoke)

Yes No

* Fire Suppression? (Water Sprinklers)

Yes No

* Security System?

Yes No

* Has your home been physically relocated or converted?

Yes No

* Is the property under construction or Remolding?

Yes No

* Is the general contractor licensed?

Yes No

Separate Risks - Is your property exposed?

Coastal Exposure:

Yes No

Earthquake:

Yes No

Flooding:

Yes No

Elevation*:

Yes No

Fire Protection**:

Yes No

Vacant Dwelling:

Yes No

* The property is elevated by artificial material (cement, steel beams) or natural material (stone, timbers).
** Is the property more than 1,000 feet from a fire hydrant or is the fire response more than 5 miles from the property?

Coverage Requested Amount

* Building / Dwelling Amount:

$

* Other structures:

$

* Personal Property:

$

* Personal Liability:

$

* Excess Liability:

$

* Guest Medical Protection:

$

* Deductible Requested:

$

 

Property 2

* Address 1:

Address 2:

* City, State / Province:

,

* Zip / Postal Code:

* Country:

* Ownership:

* Primary Use:

* Year Purchased:

* Purchase Price:

$

* Is the property currently insured?

Yes No

* Insured Value:

$

* Insurance Company:

* Annual Premium:

$

* Effective Date:

(mm/dd/yyyy)

* Do you rent or lease this property to others?

Yes No

If Yes, then for how long?

* Do you use a property management service?

Yes No

* Is this property left vacant for more than 60 days?

Yes No

* Do you employ full-time staff?

Yes No

If Yes, then how many?

* Does any full-time staffs reside at the residence?

Yes No

* Do you have a Home Business, Consultancy or Family Office?

Yes No

Property Type

* Area (square feet):

* Year built:

* Is the property located on a farm or ranch?

Yes No

* Construction type:

* Roof type:

* Primary Heat:

* Deck?

Yes No

* Pool?

Yes No

* Basement?

Yes No

* Garage?

Yes No

* Is the property Fenced?

Yes No

* Detectors?
(Fire, Gas, Smoke)

Yes No

* Fire Suppression? (Water Sprinklers)

Yes No

* Security System?

Yes No

* Has your home been physically relocated or converted?

Yes No

* Is the property under construction or Remolding?

Yes No

* Is the general contractor licensed?

Yes No

Separate Risks - Is your property exposed?

Coastal Exposure:

Yes No

Earthquake:

Yes No

Flooding:

Yes No

Elevation*:

Yes No

Fire Protection**:

Yes No

Vacant Dwelling:

Yes No

* The property is elevated by artificial material (cement, steel beams) or natural material (stone, timbers).
** Is the property more than 1,000 feet from a fire hydrant or is the fire response more than 5 miles from the property?

Coverage Requested Amount

* Building / Dwelling Amount:

$

* Other structures:

$

* Personal Property:

$

* Personal Liability:

$

* Excess Liability:

$

* Guest Medical Protection:

$

* Deductible Requested:

$

 

Property 3

* Address 1:

Address 2:

* City, State / Province:

,

* Zip / Postal Code:

* Country:

* Ownership:

* Primary Use:

* Year Purchased:

* Purchase Price:

$

* Is the property currently insured?

Yes No

* Insured Value:

$

* Insurance Company:

* Annual Premium:

$

* Effective Date:

(mm/dd/yyyy)

* Do you rent or lease this property to others?

Yes No

If Yes, then for how long?

* Do you use a property management service?

Yes No

* Is this property left vacant for more than 60 days?

Yes No

* Do you employ full-time staff?

Yes No

If Yes, then how many?

* Does any full-time staffs reside at the residence?

Yes No

* Do you have a Home Business, Consultancy or Family Office?

Yes No

Property Type

* Area (square feet):

* Year built:

* Is the property located on a farm or ranch?

Yes No

* Construction type:

* Roof type:

* Primary Heat:

* Deck?

Yes No

* Pool?

Yes No

* Basement?

Yes No

* Garage?

Yes No

* Is the property Fenced?

Yes No

* Detectors?
(Fire, Gas, Smoke)

Yes No

* Fire Suppression? (Water Sprinklers)

Yes No

* Security System?

Yes No

* Has your home been physically relocated or converted?

Yes No

* Is the property under construction or Remolding?

Yes No

* Is the general contractor licensed?

Yes No

Separate Risks - Is your property exposed?

Coastal Exposure:

Yes No

Earthquake:

Yes No

Flooding:

Yes No

Elevation*:

Yes No

Fire Protection**:

Yes No

Vacant Dwelling:

Yes No

* The property is elevated by artificial material (cement, steel beams) or natural material (stone, timbers).
** Is the property more than 1,000 feet from a fire hydrant or is the fire response more than 5 miles from the property?

Coverage Requested Amount

* Building / Dwelling Amount:

$

* Other structures:

$

* Personal Property:

$

* Personal Liability:

$

* Excess Liability:

$

* Guest Medical Protection:

$

* Deductible Requested:

$

 

Property 4

* Address 1:

Address 2:

* City, State / Province:

,

* Zip / Postal Code:

* Country:

* Ownership:

* Primary Use:

* Year Purchased:

* Purchase Price:

$

* Is the property currently insured?

Yes No

* Insured Value:

$

* Insurance Company:

* Annual Premium:

$

* Effective Date:

(mm/dd/yyyy)

* Do you rent or lease this property to others?

Yes No

If Yes, then for how long?

* Do you use a property management service?

Yes No

* Is this property left vacant for more than 60 days?

Yes No

* Do you employ full-time staff?

Yes No

If Yes, then how many?

* Does any full-time staffs reside at the residence?

Yes No

* Do you have a Home Business, Consultancy or Family Office?

Yes No

Property Type

* Area (square feet):

* Year built:

* Is the property located on a farm or ranch?

Yes No

* Construction type:

* Roof type:

* Primary Heat:

* Deck?

Yes No

* Pool?

Yes No

* Basement?

Yes No

* Garage?

Yes No

* Is the property Fenced?

Yes No

* Detectors?
(Fire, Gas, Smoke)

Yes No

* Fire Suppression? (Water Sprinklers)

Yes No

* Security System?

Yes No

* Has your home been physically relocated or converted?

Yes No

* Is the property under construction or Remolding?

Yes No

* Is the general contractor licensed?

Yes No

Separate Risks - Is your property exposed?

Coastal Exposure:

Yes No

Earthquake:

Yes No

Flooding:

Yes No

Elevation*:

Yes No

Fire Protection**:

Yes No

Vacant Dwelling:

Yes No

* The property is elevated by artificial material (cement, steel beams) or natural material (stone, timbers).
** Is the property more than 1,000 feet from a fire hydrant or is the fire response more than 5 miles from the property?

Coverage Requested Amount

* Building / Dwelling Amount:

$

* Other structures:

$

* Personal Property:

$

* Personal Liability:

$

* Excess Liability:

$

* Guest Medical Protection:

$

* Deductible Requested:

$

 

   
 
   

PHONE: +1-866-510-0149

International Insurance & Investments LLC

1725 Washington Rd. · Suite 406
Pittsburgh, PA. 15241 USA

International Insurance & Investments LLC is licensed in the European Economic Area, Switzerland, The United Kingdom and the United States of America. In the USA, the firm is licensed in 17 states. In the United Kingdom, the firm is authorized and regulated by the Financial Services Authority # 315054.


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ALL RIGHTS RESERVED.
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