Required fields are marked with asterisks (*)

Seasonal/Secondary Residence Questionnaire

Please note that completion of this form in no way confirms coverage.

It is an information gathering tool to help your agent or broker with placing coverage for you. Please fill it out with as much information as you can.

Once completed, a copy will be emailed to you for review with an agent or broker. We will never use your email address for any other purpose.

Email Address

Name & Mailing Address

Building Location same as Mailing Address

Yes

Location Address

Are there structures or buildings in the water, such as floating docks?

Yes

Please describe:

When do you use the property?

All year

Spring

Summer

Fall

Winter

How many days per week do you use the property?

Or how many days per month do you use the property?

Do you inspect the property when not in use?

Yes

How frequently?

Is this property under renovation or construction?

Yes

Start Date

Finish Date

Is this property rented to others?

Yes

Do you require the tenants to have their own insurance?

Yes

Please select if any of the following motorized equipment are allowed access on the property?

Watercraft

Golf Carts

Other

If other, please specify:

Form Builder

Seasonal/Secondary Residence Questionnaire

Please note that completion of this form in no way confirms coverage.