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Renter Insurance Quote Request FormIn order to provide you with a quote for renters insurance, please be able to answer the questions shown below. Once you have this information available, please forward the quote request to [email protected].
Please complete all information below in order to receive a valid quote. (No Post Office Box Addresses, please.)
P R O P E R T Y I N F O R M A T I O NName: (Last, First M.I.) Case Number: Visa Type: Visa Expiration Date: (MM/DD/YYYY)
Property Address:
Do you currently reside at the Property Address listed above? (If no, please provide the following. If yes, continue to mailing address section)
Is your mailing address the same as the property address? (If no, please provide the following. If yes, continue to Daytime Phone Number section)
Current Address: Current Mailing Address:
Daytime Phone Number: Policy Effective Date (Closing Date): Do you have any animals in your home? If yes, what type:
What is the total number of people living in your household? Have any of your animals ever bitten anyone? Breed of dog:
Is there a swimming pool on your property? Do you own a trampoline?
If yes, is it in-ground or above ground? Is there a diving board? Is a fence, at least 4 feet, around the pool? If yes, is there a net around the trampoline?
How many separate units in the building? Date of birth for primary insured (MM/DD/YY): Social Security Number for primary insured:
Secondary Insured (spouse): Date of birth for secondary insured (MM/DD/YY): Social Security Number for secondary insured: Occupation for primary and secondary insured:
How much personal property coverage would you like on your home? (Min. Limit $36,000) What deductible would you like? ($500, $1000)
What limit of liability would you like? ($300,000: $500,000*) What limit would you like for medical payments? ($1,000, $3,000, $5,000)
* Higher limits maybe available Some carriers only offer $10,000 medical payments.
Spouse Visa Type: Spouse Visa Expiration Date: (MM/DD/YYYY)
Email Address:
A D D I T I O N A L C O V E R A G E I N F O R M A T I O N ( not all are available with all carriers)Would you like your personal liability coverage to include libel/slander/defamation of character?
Would you like to add Earthquake Coverage to your policy?
Would you like coverage for direct physical loss due to water backup or sump pump overflow?
Would you like identity theft coverage (not available in all states)?
Do you have any personal property that you wish to schedule?
Do you have any jewelry? (If yes, please provide the following.)
Description: Value
Do you have any furs? (If yes, please provide the following.)
Description: Value
Do you have any fine art? (If yes, please provide the following.)
Description: Value
Travel Guard® Relocation Program
AIG Travel, Inc., a member of American International Group, Inc., is a worldwide leader in travel insurance solutions and assistance. Travel Guard® is the marketing name for its portfolio of travel insurance solutions and travel-related services, including assistance and security services, marketed to both leisure and business travelers around the globe. Services are provided through a network of wholly owned service centers located in Asia, Europe and the Americas. For additional information, please visit our websites at www.aig.com/travel and www.aig.com/travelguard.
© American International Group. All rights reserved. 07.14.16
SUBMIT FORMRESET FORM PRINT FORM
Save completed form and submit via email attachment to [email protected] or simply click the “Submit Form” button below when using Adobe Reader to complete form.
C L A I M S I N F O R M A T I O NHow many claims have you made in the past 5 years: Date of Loss: (MM/DD/YY) Amount of claim:
Description:
AVA I L A B L E C R E D I T SDoes the property have a fire sprinkler system?
Does the property have smoke detectors?
Does the property have a burglar alarm?
Does the property have a fire alarm?
Does the dwelling currently have fire extinguishers?
Do all external doors have deadbolt locks?
Is there a manager/24hr doorman on the premises?
Is the entrance locked?
Security/lobby cameras?
Is anyone that will be named on the policy retired?
Year of property construction: Exterior wall type: Total living square footage of the home: Total Stories:
Roof type: Roof shape: Is your home located within 1000 feet of a fire hydrant?
Do you currently have Homeowners or Renters Insurance?
