Self-Storage Insurance Application

Answer questions to the best of your knowledge and belief. All material facts must be disclosed as failure to do so may nullify any policy or certificate issued. A material fact is one likely to influence acceptance or assessment of this proposal by Insurers. If you are in any doubt as to what constitutes a material fact, you should consult your broker. If you consider that any question requires expert knowledge which you are unable to provide, indicate this in your answer.

Print Name

Please email or fax state or location specific leases to the producer listed above. Fax to :

Address

Location Specifics

Intruder Alarm
Central Station
CCTV internal & External
Is CCTV Monitored by Central Station
Fire Alarm
Central Station
Twice-Daily Walk-Thrus
Security gates and fence
Fire Hose
Smoke Detectors
Fire Extinguishers
All goods kept in enclosed bldg
Customers use units for activities
Below Street Level
Portable Heating
Pincode access to unit
Sprinklers
Stickers on locks
Live in Mgr
Guard
P&C Claims Experience Attached
History: Collapse
History: Flood
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