1-4 Family Structure Addition Form

**All additions will be added/endorsed the date that we receive your request in our office. If you have multiple additions, complete one form per property. **

Name Insured ( As Shown in policy declarations)(Required)

Policy # (e.g.; EQ123, TH123, TG123)(Required)

Contact Name (Form Completed by)(Required)

Contact Phone Number(Required)

Email Address(Required)

Property Information

Structure Type(Required)

Ownership Type(Required)

Construction Type(Required)

Other Construction-state below

Roof Type(Required)

Roof Type-Other- State below

Physical Shape of Home(Required)

Exterior Type/Siding(Required)

Exterior Siding- Other-State below

Exterior Square Foot(Required)

Number of Stories(Required)

Year Built(Required)

Year Roof Replaced(Required)

Home Under Construction/Builders Risk(Required)

Contractor

If yes, estimated completion date

Special Upgrades

Basement(Required)

Measurement of Decks ( L x W)

Measurement of Porch ( L x W )

Project Number(Required)

Unit Number(Required)

Stated Building Value(Required)

**Mobile Homes will be valued at stated value. All values will be reviewed and evaluated by the Underwriting Department.

Physical Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Occupant Name(Required)

First Last

What is the funding source of this home?(Required)

Do you (housing) hold title (deed) to this home?(Required)

Trampoline on Premise?(Required)

Central Station Burglar Alarm?(Required)

Pool on Premise?(Required)

Central Station Fire Alarm?(Required)

PHOTOS

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1-4 Family Structure Addition Form

1-4 Family Residential Structure Addition Form

Property Information