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Individual Property & Casualty
pithy6
2020-04-13T18:22:35+00:00
INDIVIDUAL INSURANCE REQUEST
INDIVIDUAL Property & Casualty
General Information
Current Property/Casualty Coverage (Check all that apply)
Auto
Homeowners
Renter's
Personal Liability
Insurance Coverage Requested (Check all that apply)
Auto/Recreational Vehicles
Homeowners/Flood/Hurricane
Condo/Renters
Personal Liability Umbrella
Jewlery/Fine Arts
Builder's Risk
Property & Casualty Underwriting Information
Once sumbitted, a representative will contact you within 24 hours.
For Auto Requests, please list all drivers in household below:
1.
Vehicle Information
2.
Vehicle Information
For Homeowner's/Condo Requests:
Property Type (Check all that apply)
Condo
Townhouse
Single Family
Du-Plex
Other
Other
Monitored Burglar/Fire Alarm?
Monitored Burglar/Fire Alarm?
Yes
No
Alarm Certificate?
Alarm Certificate?
Yes
No
Occupancy:
Occupancy:
Owner
Tenant
Type of Use (Check all that apply)
Primary Residence
Secondary
Rental
Seasonal
Months Unoccupied (Check all that apply)
Winter
Spring
Summer
Fall
None
Any claims/losses in the last 10 years?
Any claims/losses in the last 10 years?
Yes
No
For Condos
SUBMIT
Have questions? Reach out to us…
individuals@cohenncompany