Carrier - Underwriting Questions - United Insurance Group

Homeowners Questionnaire

1. Any prior losses/insurance claims in the past 3 years?(Required)

1. Please Explain(Required)

2. Any coverage declined, cancelled or non-renewed during the last 3 years?(Required)

2. Please Explain(Required)

3. Is this dwelling currently vacant or unoccupied?(Required)

3. Please Explain(Required)

4. Has any member of the entity every been convicted of a felony?(Required)

4. Please Explain(Required)

5. Is this dwelling currently for sale?(Required)

5. Please Explain(Required)

6. What is your occupation?(Required)

7. How long have you owned this property?(Required)

8. Do any household residents smoke?(Required)

9. What is distance to the nearest fire hydrant?(Required)

10. What is the distance to the nearest fire station?(Required)

11. Ay business conducted out of the insured residence?(Required)

11. Please Explain(Required)

12. Is there a trampoline on the premises?(Required)

12. Please Explain(Required)

13. Is dwelling isolated, on a farm, or outside of the city limits?(Required)

13. Please Explain(Required)

14. Any horses or other livestock owned?(Required)

14. Please Explain(Required)

15. Any wood burning appliances?(Required)

15. What type of appliance?(Required)

15. Who installed the appliance?(Required)

15. How often is it used?(Required)

16. Any dog(s) owned?(Required)

16. How many?(Required)

16. Has the dog(s) ever bitten anyone?(Required)

16. Describe size(s) and breed(s).(Required)

17. Any other insurance with United Insurance Group?(Required)

17. Policy Number?(Required)

18. Is the electrical panel on circuit breakers?(Required)

18. Please Explain(Required)

19. Are there any fuses in the dwelling?(Required)

19. Please Explain(Required)

20. Is there a pool on the premises? - Diving boards and/or Slide(Required)

20. Please provide details. Is it uncovered or unfenced?(Required)

21. Is there a hot tub on the premises?(Required)

21. Please provide details. Is it uncovered or unfenced?(Required)

22. Is the roof flat, or less than a 3/12 pitch?(Required)

22. Please Explain(Required)

23. Year roof was installed?(Required)

24. Are solar panels, solar tiles, or solar shingles installed on the property?(Required)

24. Please Explain(Required)

Auto Questionnaire

1. Has any member of your household used any illegal drugs or narcotics in the last 3 years?(Required)

1. Please Explain(Required)

2. Are any of your household vehicles driven out of the state more than 30 days per year?(Required)

2. Please Explain(Required)

3. How long have you held a U.S. license?(Required)

4. Has any member of your household had their driver's license revoked or suspended in the last 6 years?(Required)

4. Please Explain(Required)

5. Do any of your household vehicles currently have any body damage or broken or cracked glass?(Required)

5. Please Explain(Required)

6. Does any driver now have or been treated for heart trouble, high blood pressure, diabetes, dizzy spells, epilepsy, stroke, hearing or eye trouble, nervous or emotional problems, or other disabling diseases?(Required)

6. Please Explain(Required)

7. Does any driver have physical impairments or handicaps? If yes, is the vehicle specially equipped?(Required)

7. Please Explain(Required)

8. Does any driver have a license restriction other than vision?(Required)

8. Please Explain(Required)

9. Has applicant owned or operated a vehicle without liability insurance for 30 or more days in the last 6 months?(Required)

9. Please Explain(Required)

10. Has any automobile insurance been cancelled or non-renewed in the last 3 years?(Required)

10. Please Explain(Required)

11. Do you have any criminal or civil judgments against you or any household resident, or any actions or lawsuits pending?(Required)

11. Please Explain(Required)

12. Have any of the household vehicles been altered or customized, including stereo, wheels, tires, or communication equipment?(Required)

12. Please Explain(Required)

13. Is any household vehicle titled in other than the applicant's name?(Required)

13. Please Explain(Required)

14. Are any vehicles owned or operated by members of your household that are not insured under this policy?(Required)

14. Please Explain(Required)

15. Are any of your household vehicles used in any home business or commercial venture, including food or newspaper delivery?(Required)

15. Please Explain(Required)

16. Are there any others (including children not residing with you) that may drive your vehicles?(Required)

16. Please Explain(Required)

Landlord / Dwelling Fire Questionnaire

1. Any prior losses/insurance claims in the past 3 years?(Required)

1. Please Explain(Required)

2. Has coverage ever been declined or cancelled in the past 3 years?(Required)

2. Please Explain(Required)

3. Is this dwelling currently vacant or unoccupied?(Required)

3. Please Explain(Required)

4. Has any member of the entity ever been convicted of a felony?(Required)

4. Please Explain(Required)

5. Is this dwelling currently for sale?(Required)

5. Please Explain(Required)

6. What is your occupation?(Required)

7. How long have you owned this property?(Required)

8. What was the purchase price of this dwelling?(Required)

9. What is the distance to the nearest fire hydrant?(Required)

10. What is the distance to the nearest fire station?(Required)

11. What is the distance to the nearest neighbor?(Required)

12. Is dwelling isolated, on a farm, or outside of the city limits?(Required)

12. Please Explain(Required)

13. Any wood burning appliance?(Required)

13. Who installed the appliance?(Required)

13. How often is it used?(Required)

13. What type of applicance?(Required)

14. Any other insurance with United Insurance Group?(Required)

14. Policy Number?(Required)

15. Is the electrical panel on circuit breakers?(Required)

15. Please Explain(Required)

16. Are there any fuses in the dwelling?(Required)

16. Please Explain(Required)

17. Is there a pool on the premises? - Diving boards and/or Slide(Required)

17. Please provide details. Is it uncovered or unfenced?(Required)

18. Is there a hot tub on the premises?(Required)

18. Please provide details. Is it uncovered or unfenced?(Required)

19. Is the roof flat, or less than a 3/12 pitch?(Required)

19. Please Explain(Required)

20. Year roof was installed?(Required)

21. Are solar panels, solar tiles, or solar shingles installed on the property?(Required)

21. Please Explain(Required)

22. Is this a single family home converted to a multi-family rental?(Required)

22. Please Explain(Required)

23. Is this unit listed on a VRBO, AIRBNB or other on-line site?(Required)

23. Please Explain(Required)