North Carolina Homeowners Insurance Application Questions

ALLCHOICE Agent Information

Select Your Advisor*

INSURED INFORMATION

Name*

First Last

Address*

Street Address City State ZIP Code

Mobile Phone*

Email*

HOME INSURANCE QUESTIONS

Is the dwelling at the indicated property currently owned and occupied as your primary residence?

Yes
No

Explain

Have you ever had similar insurance on this property or any other property during the past 5 years?

Yes
No

Which Company(ies)

EXCEPT for non-payment of premium, has any company declined, cancelled, or refused to renew similar insurance?

Yes
No

Explain

Have you had any losses or claims of any nature, whether insured or not, such as fire, windstorm, theft, liability, etc. on this or any other property during the last 5 years?

Yes
No

Explain (Year, Approx Cost, Cause)

When was the property purchased (MM/YYYY)

Are there any wood burning stoves, wood burning fireplace inserts, wood burning furnaces, space heaters, or kerosene heaters on the premises?

Yes
No

Required Information

1. Manufacturer Of Wood Stove 2. How Often Is Wood Stove Cleaned 3. Date Of The Last Cleaning

Is there a swimming pool on the premises?

Yes
No

Above Ground? Inground? Pool Enclosed By Fence?

Are there animals, including farm animals or pets on the premises?

Yes
No

Provide Animal Type(s) (If Dog include breed) (are any animals dangerous or show propensity to bite)

Is the applicant conducting any business or occupational pursuits at the premises?

Yes
No

Explain

Date of Last Roof Update (if none write "NONE")

Date of Last Electrical Update (if none write "NONE")

Date of Last Plumbing Update (if none write "NONE")

Date of Last HVAC Update (if none write "NONE")