Contents Quote - Formstack

Insured Information

Name*

First Name

Last Name

Will there be a Co-Insured?*

Does someone else own the contents with you?

Co-Insured Name

First Name

Last Name

Phone Number

Date of Birth*

What is your Occupation?*

Name of Apartment Complex or Development?

House / Unit Number*

Street Address*

District*

Type of Occupany:*

How many Adults occupy the home?*

How many Chilren occupy the home?*

Type of Dwelling*

What are the walls constructed of?*

What is the roof constructed of?*

Which of the following Special Features do you have in your home*

Hurricane Shutters / Storm Rated Windows Home Security System Fire Suppression System Flood Detector System None

Proximity to the water?*

Do you employ a Domestic Helper?*

Have you had any Incidents/Claims within the last 5 years?*

Please describe the incident / claim:*

Your Contents

Total Value of Contents:*

KYD Dollar

Do you have any individual item that exceeds $2,500 KYD in value?*

Please list the items:

Description and Value

Where did you hear about us?

Declaration

This information has been collected to determine a quotation. The collection of a quotation by Saxon Motor & General Insurance Company Ltd. does not constitute acceptance of insurance. Insurance will not commence until we have a completed proposal form, and Saxon Motor & General Insurance Company has indicated acceptance of this application.