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Wednesday, 22 Feb 2012
Home Coverage Quote
  1. Full Name(*)
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  2. Occupation
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  3. Place of Employment
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  4. Street Address(*)
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  5. PO Box
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  6. Settlement, Island(*)
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  7. Email(*)
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  8. Telephone(*)
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  9. Work Phone
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  10. Fax
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  11.  
  1. Previously Insured?(*)
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  2. Have you had any insurance refused or subjected to special terms?(*)
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  3. Have you had any losses during the past 3 years?(*)
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  4. Have you been convicted of, or have been charged with but not yet tried for, arson or any offence involving dishonesty of any kind such as fraud, robbery, theft, or handling stolen goods?(*)
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  5. If you have answered “YES” to any of these questions, please provide full details below.
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  6.  
  1. Mortgagee (if any)
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  2. Coverage Required From

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  3. Coverage Required To

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  4. Exact Location(*)
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  5. Building Construction
  6. Walls
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  7. Roof
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  8. Distance From the Sea
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  9. How High Above Sea Level
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  10. Year Built
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  11. Number of Stories
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  12. Number of Bedrooms
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  13. Square Footage
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  14. Property is a (Hold down ctrl to select multiple items)
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  15. Are the buildings






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  16. Has there been any claims in the last 3 years?
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  17. Are the Buildings ever unoccupied?
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  18. If so, for how many weeks a year?
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  19. Was the property built in full accordance with The Bahamas Building Code?
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  20.  
  1. Type of Perils (Select One)(*)
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  2. Sums Insured
  3. BUILDINGS (including fitted carpets, air conditioning units, outbuildings, walls, gates, swimming pools, etc. Seawalls, canal walls, docks, satellite equipment and television antennae are not included and should be separately insured below)
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  4. CONTENTS (including furnishings and all personal effects)
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  5. “ALL RISKS” (List each item and value separately)
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  6. SEA WALL/CANAL WALL
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  7. DOCK
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  8. SATELLITE EQUIPMENT
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  9. TELEVISION ANTENNA
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  10. OTHER COVERAGE (as more fully described hereunder)
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  11. ADDITIONAL COVER (available at additional premium)



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  12. Total
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  13. REPLACEMENT COST - Can you replace items 1 to 7 for the amounts stated?
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  14.  
  1. I declare to the best of my knowledge and belief the information on this form is true in every respect. I also declare that if anything on this form was written by another person, he or she acted as my agent for this purpose. I agree to keep the property in a good state of repair during the currency of this Insurance. I agree that this proposal and declaration will be the basis of the contract between me and the Insurer.
  2. By selecting the submit button you agree to this statement.
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