For 11+ PadSplit Properties

Contact Information

Policy Holder Name

Billing Address

City

State

Zip

Contact Name

Phone Number

Alternative Phone Number

Email

Years In Business

Has applicant ever filed for bankruptcy?

Property Information

Upload Property Information Document

(Download template above or upload your own preexisting document)

Property Information File

Underwriting Information

Do you make physical inspections of the properties?

How often are inspections made?

Who performs the inspections?

Do inspections include safety and physical hazards at each location (i.e. entryways, stairs, railings for loose boards, bricks, stones, handrails)?

How quickly are repairs made?

Are vacant* properties secured and inspected?

How long are units vacant between tenants?


*the policy requires vacant locations to be secured and inspected monthly

Prior Coverage & Loss History

Please list all losses the past 5 years (date of loss, type, amount paid, and open/closed status).

Final Steps

Applicant's Name

Applicant's Title

Application Date

*Please ensure you see the on-screen confirmation message in a green box after submitting your application.*

Δ