UNDERWRITING INFORMATION FOR HOME INSURANCE房屋保險房屋保險房屋保險房屋保險-投保資料投保資料投保資料投保資料OWNERS NAME(s) 投保人姓名： Date of Birth 出生日期：FULL ADDRESS 地址： Postal Code 郵政區編號：HOW MANY FAMILIES ARE LIVING IN THIS HOUSE: 請列明有多少個家庭戶口住在上址：Non-Smokers? Yes □ No □ 住客中是否有吸煙者：是 □ 否 □ USE OF HOUSE e.g. primary residence, rental, etc. 此物業是自住或是出租與他人：ANY RENTAL ROOM? 有多少名租戶：EXISTING POLICY INSURER: 請提供目前之保險公司名稱：POLICY NUMBER AND EXPIRY DATE: 保單號碼及該保單之有效日期：Existing Policy Building Limit (if NOT condo): e.g. $400,000, can be found in your existing policy 請列出保單上該物業之投保價值，如$400,000

Building Information:

Age of bldg (year built) 請列出該物業之樓齡：How many storeys 樓高多少層：Type of bldg: e.g. detached; townhouse; condo, etc.: 物業種類： 獨立屋 □ 鎮屋 □ 排屋 □ 或共管柏文大廈 □ Garage e.g. detached double garage 單車房 □ 雙車房 □ 或其他 □

Exterior Wall e.g. brick, Frame, masonry; aluminium sidings - 房屋外牆物料：磚 % 木 % 鋁片 % 石 %

Interior Wall e.g. plaster, drywall - 內牆物料：（例如：灰泥，石膏板） %

Roof e.g. shingles and % 屋頂物料： %

Ceiling - e.g. 8 ft, 10 ft % 樓底高度 - 例如八呎 /十呎:

Living room - area & floor (e.g. carpet, hardwood, tiles)客廳面積及材料：Dining room - area & floor (e.g. carpet, hardwood, tiles)飯廳面積及材料：Family room - area & floor (e.g. carpet, hardwood, tiles)家庭廳及材料：No. of bedrooms and area of each bedroom睡房數目及房間面積：No. of Kitchens; area & floor (e.g. ceremic tiles, etc.)廚房數目及面積： 地面材料：Other rooms - no. and area其他房間數目及房間面積：Basement - finished/unfinished; area or % 地庫是否完成： % 或面積：Other areas (e.g. corridors, laundry room etc) - approx. area 其他地方面積(包括：走廊、洗衣房、或其他)

Total Living area (total of the above):住房活動空間總面積：No. of bathrooms:洗手間數目：2-piece (toilet & basin) - how many兩件頭（包括：坐廁及洗手盆）數目：3-piece (toilet, basin & shower or bathtub) - how many三件頭（包括：坐廁、洗手盆、花灑或浴缸）數目：Ensuite; 4-piece (toilet, basin, shower and bathtub) - how many四件頭（包括：坐廁、洗手盆、花灑及浴缸）數目：Airconditioning system - yes/no空氣調節設備：有 □ 否 □ ： 種類：中央系統 懸掛式 數目：Heating system - type e.g. forced air furnace; wood stove etc暖氣系統資料：Fireplace - no. and type of Fireplace:火爐：有 □ 否 □ 種類：Plumbing - pipes are copper, plastic or others?水管種類（銅、塑料或其他）：Electrical - 100 amp?電力供應資料：Burglary alarm - yes/no; monitored - yes/no 防盜系統安裝：是 □ 否 □ 有否接駁到監察台：No. of Smoke detectors ; monitored - Yes/no 煙霧探測器之數目 ，是否接駁到監察台：是 □ 否 □

Is fire hydrant in the vicinity of your house? Yes/no 物業附近是否安裝有政府之救火街喉: 是 □ 否 □

Is firehall within 8km of your house? Yes/no 在物業之八公里內是否設有消防局？ 是 □ 否 □Outbuildings e.g. enclosed porch; gazebo; garden shed … 物業/屋外是否設有其他建築物如防風間格,太陽房, 或其他各式加建之設施Swimming pool - Yes/no 物業是否設有私家游泳池？ 是 □ 否 □

Other additions e.g. extra kitchen, skylights, hot tub; jacuzzi/jetted tub; wet bar 其他設施，如天窗，水吧，按摩池等，If building over 20 years old, need when update been made for - Roof; electricical; plumbing; heating/aircon systems etc.: 如樓齡超過廿年，請列出以下設施於何時更新如樓齡超過廿年，請列出以下設施於何時更新如樓齡超過廿年，請列出以下設施於何時更新如樓齡超過廿年，請列出以下設施於何時更新 : 屋頂屋頂屋頂屋頂 電線及電婊板電線及電婊板電線及電婊板電線及電婊板 水管水管水管水管 冷暖氣冷暖氣冷暖氣冷暖氣NOTE: we cannot provide home insurance in which the house has any commercial activity e.g. clinic or it is a multi-tenant occupancy 請泩意：此特惠保險不適用於有任何商業活動之家居，如分租或家居診所Claims History - any claim or loss in the past 6 years. If so, provide date, details of claim/loss 閣下於過去六年有否索 償？請列出賠償事固及金額Any Other comments and/or Information:

Name/Address of Mortgagee:銀行或按謁公司名稱及地址How long have you been in this present premises?閣下於此物業居住多久？How long has you have home insurance?閣於何時開始購買房屋保險？