Homeowners Renewal Questionnaire

Are you an Agent?. *

I am an Agent entering information for an Insured
I am Not an Agent

First Name *

Last Name *

Home Phone

Cell

Work Phone

Policy Number *

Please verify your policy number is correct.

Enter the physical address of the home for the above policy

Address *

City *

State *

Postal Code *

Confirm the Survey *

I hereby attest that the information provided herein is up to date and accurate to the best of my knowledge.

Original Year of Construction *

Have you made any of the following improvements or updates to your home?

Heating

Heating
No update to Heating

Heating Date Complete *

Date Complete

Heating Partial/Complete *

Partial
Complete

Plumbing

Plumbing
No update to Plumbing

Plumbing Date Complete *

Date Complete

Plumbing Partial/Complete *

Partial
Complete

Roof

Roof
No update to Roof

Roof Date Complete *

Date Complete

Roof Partial/Complete *

Partial
Complete

New roof is Standing Seam

New roof is Standing Seam
New roof is not Standing Seam

Electrical

Electrical
No update to Electrical

Electrical Date Complete *

Date Complete

Electrical Partial/Complete *

Partial
Complete

Have you made any alterations or additions to your home in the last 3 years?

Finished Basement

Finished Basement
No update to Finished Basement

Basement Date Complete *

Date Complete

Basement Value *

Kitchen

Kitchen
No update to Kitchen

Kitchen Date Complete *

Date Complete

Kitchen Value *

Addition

Addition
No update to Addition

Addition Date Complete *

Date Complete

Addition Value *

Garage/Carport

Garage/Carport
No update to Garage/Carport

Garage/Carport Date Complete *

Date Complete

Garage/Carport Value

Bathroom

Bathroom
No update to Bathroom

Bathroom Date Complete *

Date Complete

Bathroom Value

Solar Panels

Solar Panels
No update to Solar Panels

Solar Panels Date Complete *

Date Complete

Solar Panels Value *

Number of Solar Panels *

Panels Attached? *

Other

Other
No update on Other

Other Date Complete *

Date Complete

Other Value *

Is this your Primary Residence? *

Secondary or Seasonal Short Term Rental *

Secondary
Seasonal Short Term Rental

Business activities conducted on premises

There is farming or other business activities conducted on the premises
Farming or other business activities are not conducted on the premises

Please provide details of activities *

Is this a log home? *

Custom or Built from a Kit *

Built from a kit
Custom

Does your home use the following? *

Wood Burning Fireplace
Wood Stove
Neither Wood or Fireplace

Was the unit professionally installed? *

Do any of the following exist on the premises?

Trampoline
Treehouse
Swimming Pool
No Swimming Pool, Trampoline, or Treehouse

About the Pool

Pool is above-ground
Pool area fenced and equipped with a locking gate
Pool has a slide
Pool has a diving board

Do you own any dogs? *

What is/are the breed(s) of dog(s) *

Do/Does the dog(s) have a bite history? *

Please provide details of incident *

Do you own any exotic pets? *

Please provide type of exotic pet *

Is your home equipped with a security device? *

Security Devices

Central Station Alarm 5% Credit
Smart home security such as Canary or NEST system 2% Credit
No Central Station Alarm, No Smart home security.

Is your home equipped with a smart home device? *

Smart Devices

Active Smart Home Device
Passive Smart Home Device
No Active Smart Home Device, No Passive Smart Home Device

Is your home equipped with a generator? *

Permanently Installed or Portable Generator *

Permanently installed
Portable

Are there underground oil or gasoline storage tanks located on the premises? *

Would you be interested in taking advantage of an Electronic Delivery Option? *

Authorize the Union Mutual Customer Support Team to set up electronic delivery? *

Yes. I authorize the Union Mutual Customer Support Team to set up electronic delivery.

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