For manual submission, download this form here.
PERSONAL LIABILITY QUESTIONNAIRE
TO BE COMPLETED AND SIGNED
BY THE INSURED
. ALL VALUES ARE SUBJECT TO REVIEW BY UNDERWRITING.
PLEASE CHECK OFF ALL APPLICABLE ITEMS:
Additional location
Additional house on same property
Boarder in house
Farm tractors
Number of tractors:
Office or studio in house
Use:
Permanent resident employees
Pool
Hot tub
Pond
Sailboats
Length:
Watercraft
Quantity:
Length:
Horsepower:
Well supplying water to additional households
Custom farming
describe:
Daycare/babysitting in house
Number of kids:
Dog kennel/pet boarding
Number of kennels:
Training non-owned dogs
Maximum quantity on property:
Farm produce
Pick your own
Sale from roadside
Type of produce:
Farm vacations / Bed & Breakfast
Number of rooms:
Boat a/o trailer storage
Maximum quantity on property:
Sale of any goods or order taking
describe:
Small motor repair
Snow plowing
Machine shop
Airplane / Helicopter landing strip
SIGNATURE (ENTER YOUR NAME)
*
:
date signed
D
M
YEAR
