The document is a homeowner's insurance questionnaire that collects detailed information about the home, including its features, systems, and dimensions. It asks for specifics like type of dwelling, age, square footage, and details on plumbing, electrical, roofing, and heating systems. The questionnaire includes options for various aspects of the property to assist in assessing insurance needs.

1. (1st, bi-level, etc.)
Bo Knows Homes (204) 333-2202
Porch or Sunroom
Yes / No
Size _________
Yes / No
Wood Burning / Natural Gas
Hot Tub or Pool
Yes / No
Size _______
Deck
Yes / No
Square Footage ________
Made of _________
Electrical Systems
Panel
Circuit Breakers ! ______%
Fuse Panel ! _______%
Fuse Panel- Tamper Proof !
Year Updated __________
Electrical Service
60 Amp !
70 Amp !
100 Amp !
200 Amp !
Other ! _______ Amp
Wiring
Copper ! ___%
Aluminum ! ___%
Knob and Tube ! ___%
Year Updated _______
Roofing
Asphalt Shingles !
Wooden Shingles !
Metal !
Rubber !
Tar & Gravel !
Other !
Darcy Cook (204) 237-4025
Homeowner’s Insurance Questionnaire
Address ____________________________________________________________________
Type of dwelling _______________________________ Age of dwelling ________________
Square Footage of Home ______________ Square Footage of Basement ________________
Flooring Garage Fireplace
Yes / No
Attached / Detached
Single / Double / Triple
Plumbing Systems
Pressure Lines
Galvanized ! ___%
Copper ! ___%
Plastic/PVC/ABS/PEX ! ___%
Year Updated __________
Hot Water
Standard Tank !
Tankless !
Year Updated ______
Sewer System
Sump Pump in a Pit !
Backwater Valve !
Throat Valve !
In-line Valve !
Carpet ! _______%
Laminate ! ______%
Hardwood ! _____%
Vinyl ! _______%
Ceramic ! ______%
Other ! _______%
Heating Systems
Forced Air Furnace !
Hot Water/Boiler !
Electric Baseboard !
Hydronic/In Floor !
Geo Thermal !
Woodstove !
Central A/C !
Fuel
Natural Gas !
Electricity !
Oil !
Other ! ____________
B