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Insurance Tcm Form


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Insurance Tcm Form

  1. 1. UNDERWRITING INFORMATION FOR HOME INSURANCE 料資保投 險保屋房 料資保投 險保屋房 料資保投 險保屋房 料資保投 險保屋房 - OWNERS NAME(s) :名姓人保投 :期日生出 Date of Birth FULL ADDRESS :址地 :號編區政郵 Postal Code HOW MANY FAMILIES ARE LIVING IN THIS HOUSE: :址上在住口戶庭家個少多有明列請 Non-Smokers? Yes □ No □ 否 是:者煙吸有否是中客住 □ □ USE OF HOUSE e.g. primary residence, rental, etc. :人他與租出是或住自是業物此 ANY RENTAL ROOM? :戶租名少多有 EXISTING POLICY INSURER: :稱名司公險保之前目供提請 POLICY NUMBER AND EXPIRY DATE: :期日效有之單保該及碼號單保 Existing Policy Building Limit (if NOT condo): e.g. $400,000, can be found in your existing policy 如,值價保投之業物該上單保出列請 $400,000 Building Information: Age of bldg (year built) :齡樓之業物該出列請 How many storeys :層少多高樓 Type of bldg: e.g. detached; townhouse; condo, etc.: 屋排 屋鎮 屋立獨 :類種業物 □ 廈大文柏管共或 □ □ □ Garage e.g. detached double garage 房車單 他其或 房車雙 □ □ □ Exterior Wall e.g. brick, Frame, masonry; aluminium sidings - 石 片鋁 木 磚:料物牆外屋房 % % % % Interior Wall e.g. plaster, drywall - )板膏石,泥灰:如例(:料物牆內 % Roof e.g. shingles and % :料物頂屋 % Ceiling - e.g. 8 ft, 10 ft 呎十 呎八如例 度高底樓 % - / : Living room - area & floor (e.g. carpet, hardwood, tiles) :料材及積面廳客 Dining room - area & floor (e.g. carpet, hardwood, tiles) :料材及積面廳飯 Family room - area & floor (e.g. carpet, hardwood, tiles) :料材及廳庭家 No. of bedrooms and area of each bedroom :積面間房及目數房睡 No. of Kitchens; area & floor (e.g. ceremic tiles, etc.) :料材面地 :積面及目數房廚 Other rooms - no. and area :積面間房及目數間房他其 Basement - finished/unfinished; area :積面或 :成完否是庫地 or % % Other areas (e.g. corridors, laundry room etc) - approx. area 他其或、房衣洗、廊走:括包 積面方地他其 ( ) Total Living area (total of the above): :積面總間空動活房住 No. of bathrooms: :目數間手洗 2-piece (toilet & basin) - how many :目數)盆手洗及廁坐:括包(頭件兩 3-piece (toilet, basin & shower or bathtub) - how many :目數)缸浴或灑花、盆手洗、廁坐:括包(頭件三 Ensuite; 4-piece (toilet, basin, shower and bathtub) - how many :目數)缸浴及灑花、盆手洗、廁坐:括包(頭件四 Airconditioning system - yes/no :目數 式掛懸 統系央中:類種 : 否 有:備設節調氣空 □ □ Heating system - type e.g. forced air furnace; wood stove etc :料資統系氣暖 Fireplace - no. and type of Fireplace: :類種 否 有:爐火 □ □ Plumbing - pipes are copper, plastic or others? :)他其或料塑、銅(類種管水 Electrical - 100 amp? :料資應供力電 Burglary alarm - yes/no; monitored - yes/no :台察監到駁接否有 否 是:裝安統系盜防 □ □ No. of Smoke detectors 否 是:台察監到駁接否是, 目數之器測探霧煙 ; monitored - Yes/no □ □ Is fire hydrant in the vicinity of your house? Yes/no 否 是 喉街火救之府政有裝安否是近附業物 : □ □ Is firehall within 8km of your house? Yes/no 否 是 ?局防消有設否是內里公八之業物在 □ □ Outbuildings e.g. enclosed porch; gazebo; garden shed … / , , 施設之建加式各他其或 房陽太 格間風防如物築建他其有設否是外屋 業物 Swimming pool - Yes/no 否 是 ?池泳游家私有設否是業物 □ □ Other additions e.g. extra kitchen, skylights, hot tub; jacuzzi/jetted tub; wet bar ,等池摩按,吧水,窗天如,施設他其 If building over 20 years old, need when update been made for - Roof; electricical; plumbing; heating/aircon systems etc.: 板婊電及線電 板婊電及線電 板婊電及線電 板婊電及線電 頂屋 新更時何於施設下以出列請,年廿過超齡樓如 頂屋 新更時何於施設下以出列請,年廿過超齡樓如 頂屋 新更時何於施設下以出列請,年廿過超齡樓如 頂屋 新更時何於施設下以出列請,年廿過超齡樓如 : 氣暖冷 管水 氣暖冷 管水 氣暖冷 管水 氣暖冷 管水 NOTE: we cannot provide home insurance in which the house has any commercial activity e.g. clinic or it is a multi-tenant occupancy 所診居家或租分如,居家之動活業商何任有於用適不險保惠特此:意泩請 Claims History - any claim or loss in the past 6 years. If so, provide date, details of claim/loss 額金及固事償賠出列請?償 索否有年六去過於下閣 Any Other comments and/or Information: Name/Address of Mortgagee: 址地及稱名司公謁按或行銀 How long have you been in this present premises? ?久多住居業物此於下閣 How long has you have home insurance? ?險保屋房買購始開時何於閣