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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.

Amounts are in USD

Client Information:
*Title :**
*First Name :**
*Last Name :**
*Email (documents will be sent to this email address) :**
*Legal Name Appearing on the Policy is same as Client Name:**	Yes No
Please specify:

Vacant Property Address:
*Address Line 1 :**
Address Line 2 :
*City :**
*Zip / Postal Code :**
*Country :**
*State / Province / Region :**

Mailing Address:

Same as Vacant Property Address*: Yes No

Details of Vacant Property:
*Construction :**
*Heating :**
*Wood Stove :**	Yes No
*Year of Construction (yyyy) :**

Coverage Options:
*Insurance Limit Requested on Building :**
*Personal Liability Amount Requested :**
*Home Contents Limit :**	Other
*Continuing Expense Coverage :** 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.	Other
*Earthquake Protection :**	Yes No
*Flood Protection :**	Yes No
*Do you live by any streams of water? :**	Yes No
Effective Date of Policy (yyyy-mm-dd)*:
*Policy Period (In Months) :**	12

Mortgage Information - First Mortgagee / Loss Payee :

Is there a mortgagee for this dwelling ? *: Yes No

Bank Name :

Address Line 1 :

Address Line 2 :

City :

Country :

State / Province / Region :

Zip / Postal Code :

Mortgage Information - Second Mortgagee / Loss Payee :

Is there a second mortgagee for this dewelling ? *: Yes No

Loss Details:
Have you ever been refused property insurance ? *	Yes No

*How many residential losses have you suffered in the past three (3) years? :**

Please enter the details below:

Please specify the details for the last 3 losses below:

Date of Loss (yyyy-mm-dd):		Final Loss Amount :
Details of Loss :

Date of Loss (yyyy-mm-dd):		Final Loss Amount :
Details of Loss :

Date of Loss (yyyy-mm-dd):		Final Loss Amount :
Details of Loss :

On Site Security:
Strongly recommended if house value is exceeding 200,000.
*Central Station Fire Alarm :**	Yes No
*Central Station Burglary Alarm :**	Yes No
Other, Please Specify:

Occupancy:
*Type of Occupancy :**	Other
*Commercial or Semi Commercial :**	Yes No
*Secondary / Seasonal :**	Yes No

Is this Location Currently...:
*Under Renovations ?:**	Yes No
*Under Construction ?:**	Yes No
Do you expect your dwelling to undergo any renovations or construction during its vacancy period? *	Yes No
If yes, explain:

Public Protection:
Is your dwelling within 1,000 feet (300 meters) of a fire hydrant? *	Yes No
Is your dwelling within 5 miles (8 km) of a fire station? *	Yes No

Supplementary Information:
Who will be responsible for the care and maintenance of your vacant dwelling while you are away? *
Will this person maintain a regular visitation schedule to your home? *	Yes No
If yes, approximately how often per month will they visit?

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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