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Loss Examples

FAQ

Vacant Homes and Tenant Occupied Properties Application Form

Please fill out the application form below and click the Submit button to obtain a quote from XN Financial.

Required fields are identified by an asterisk.

If the submitted form does not pass validation, a list of fields will appear with a brief explanation and the respective fields will be highlighted in red throughout the form.

Is the following information correct?

Press the "Submit" button to send the request.

Amounts are in

Client Information:
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*Legal Name Appearing on the Policy is same as Client Name:**
Please specify:

Vacant Property Address:
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:
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Mailing Address:

Same as Vacant Property Address*:

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Details of Vacant Property:
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Coverage Options:
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*: To pay the cost of utilities, mortgage principal, interest and taxes following a covered loss obligating you to temporarily remove this dwelling from the real estate market.
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*(yyyy-mm-dd):**
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Mortgage Information - First Mortgagee / Loss Payee :

Mortgage Information - Second Mortgagee / Loss Payee :

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Loss Details:
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Please enter the details below:

Please specify the details for the last 3 losses below:

(yyyy-mm-dd):		:
:

(yyyy-mm-dd):		:
:

(yyyy-mm-dd):		:
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On Site Security:
Strongly recommended if house value is exceeding 200,000.
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Other, Please Specify:

Occupancy:
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Is this Location Currently...:
*?:**
*?:**
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If yes, explain:

Public Protection:
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Supplementary Information:
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*

If you encounter any problems or need assistance with this website,
please contact pcservice@xn.com.
The XN Financial Underwriting department.

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