Citizens Application Underwriting Questions
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
Has any applicant been canceled or nonrenewed for material misrepresentation on an application for insurance or on a claim in the past 15 years? *
Has any applicant been canceled, convicted or pleaded no contest for insurance fraud in the past 15 years? *
Has any applicant been convicted or pleaded no contest for arson in the past 15 years? *
Is home currently condemned? *
Any structure partially or entirely over water? *
Is the roof damaged or does the roof have visible signs of leaks? *
Is the dwelling used as a fraternity or sorority house or any similar housing arrangement? *
Is there any Home Day Care conducted on the residence premises? *
Does the dwelling show signs of settlement or cracking of the walls, floor or foundations? *
Are there any signs of sinkhole activity on the property such as shifting, or bulging of a foundation, wall, or roof? *
Does any person who will be insured under this policy have knowledge that repairs have been made to the dwelling and/or property relating to sinkhole activity? *
Does the dwelling have any existing damage? *
Is the property in a state of disrepair? *
Is the dwelling, or other structure homemade, rebuilt or constructed with extensive remodeling on a 'Do-It-Yourself' basis? *
Was the dwelling originally built for purposes other than a residence and later converted for residential use? *
Is the property located on landfill previously used for refuse? *
Is the property readily accessible year round to fire fighting equipment? *
Is the property located on a barrier island? *
Is the dwelling rented for periods of 30 days or less? *
Is the dwelling advertised or held out for rental to guests for short term rental periods? *
Is there a swimming pool or similar structure? *
Is there a trampoline on the premises? *
Is there a skateboard ramp? *
Is there a bicycle ramp? *
Is there an empty in-ground pool or similar structure? *
Are there outdoor appliance(s)? *
Are there inoperable motor vehicle(s) not secured in the garage or structure? *
Are there horses or livestock used for business? *
Are there other unusual or dangerous conditions? *
Are there any vicious or exotic animals on premises? *
Has any named insured had a foreclosure, repossession or bankruptcy during the past five (5) years? *
Is the property located within 1,500 feet of salt water? *
Is the dwelling within 40 feet of a commercial structure? *
Was the dwelling ever moved from its original foundation? *
Is the dwelling built on a continuous masonry foundation? *
Is there any business*, whether for profit or not, conducted on the residence premises including: religious services, animal or other attraction visitation, any care of adults or children, farming or media production with on-site production crews?
(*Does not include Home Day Care) *
Does any person who will be insured under this policy have knowledge of any sinkhole investigation, ground study, structural evaluation, and/or sinkhole inspection performed
due to a sinkhole claim or for any reason other than an inspection to request sinkhole insurance for the property? *
Important NoticeAny
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
contact us. Per the terms of our
online privacy policy we will not resell your information to any third-party.
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